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Year’s Top 10 Lab Stories Contain Surprises & Twists

CEO SUMMARY: With the SARS-CoV-2 pandemic now in the rearview mirror of the nation’s clinical labs and pathology groups, the important news stories of 2023 were mostly about developments where the consequences will influence laboratory operations in coming years. Artificial intelligence…

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Big Employers Sue Payers over Price Transparency

CEO SUMMARY: Feeling they’ve been denied access by insurance companies to price data about medical claim payments, self-funded employer plans and unions are taking their health insurance companies…

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UnitedHealthcare’s Z-code Policy Starts on Aug. 1

CEO SUMMARY: UnitedHealthcare’s (UHC) response to the ever-growing number of unique genetic tests and the continuing growth in the volume of those claims is a new policy. Effective Aug. 1, UHC will require a Z-code with genetic test claims. This req…

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Coverage, Reimbursement Still Difficult for New Lab Tests

CEO SUMMARY: Bringing a new proprietary diagnostic test to market is an arduous process. It takes patience and planning to complete the journey from test development to payer reimbursement. This slow process stems from the fact that the healthcare reimbursement system is fragmented,…

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August 8, 2022 Intelligence: Late-Breaking Lab News

One of the biggest health insurers in the United States has changed its name. As of June 28, Anthem in Indianapolis, Ind., is now known as Elevance Health. The new name is a combination of “elevate” and “advance,” noted Modern Health Executive on June 16. Elevance also an…

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Optum to Offer Laboratory Benefits Management to other Health Plans

This is an excerpt of a 1,355-word article in the June 21, 2022 issue of  THE DARK REPORT. The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: UnitedHealth Group subsidiary Optum announced a new laboratory benefits management program aimed at impr…

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UnitedHealth’s Optum to Offer Lab Test Management

CEO SUMMARY: UnitedHealth Group subsidiary Optum announced a new laboratory benefits management program aimed at improving utilization of genetic/molecular clinical laboratory testing. The goal is to save health plans money while bringing genetic test validity data prominently into …

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Insurers Get Aggressive with Years-Old Audits, Searching for Lab Overpayments

This is an excerpt of a 1,971-word article in the July 26, 2021 issue of  THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: Not only are health insurers looking back to find lab overpayments and funds paid erroneously, but…

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Insurers Get Aggressive with Years-Old Audits

CEO SUMMARY: Not only are health insurers looking back to find overpayments and funds paid erroneously, but payers also are requiring documentation for overpayments. If clinical labs and anatomic pathology groups do not appeal such claims quickly, they may be liable for any amount i…

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How to Achieve Success with Genetic Test Prior Authorization

AS MANAGED CARE PAYERS INCREASINGLY REQUIRE PRIOR AUTHORIZATION FOC GENETIC TESTS, clinical laboratories should understand the ins and outs of what it takes to get reimbursed for testing they provide.  Almost all payers now require prior authorization (P…

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