CEO SUMMARY: Since the July 1 launch of its prior-authorization program for genetic tests, Anthem and its subsidiary, AIM Specialty Health, have authorized few genetic tests, said a national lab. Lab directors say they have been unable to communicate with Anthem/AIM when client physicians order tests. Also, labs are unaware if Anthem has trained ordering
Tag: lab benefit management
CEO SUMMARY: Once Anthem and UnitedHealthcare establish their respective genetic test prior-authorization programs, a new era for genetic testing will commence. The 80 million beneficiaries served by these two payers make up half of the individuals who have private health insurance. It is reasonable to expect that other health insurers will follow the lead of
CEO SUMMARY: UnitedHealthcare will not implement the claims impact part of its laboratory benefit management program in Texas on March 1, 2017, as it had previously announced. Opposition to the program and the requirement that physicians use the BeaconLBS system when ordering about 79 lab tests is building among physicians in Texas. Officials from the
CEO SUMMARY: A 22-physician pathology group in Tampa has complied with rules for lab test ordering that UnitedHealthcare and BeaconLBS established, yet has experienced a steep decline in the volume of specimens it receives. Physicians told the pathologists that other labs were not using the BeaconLBS system or were not asking their clients to use
THE DARK REPORT is first to report on the latest development as part of its ongoing coverage of how Florida physicians are reacting to the implementation of the UnitedHealthCare laboratory benefits management program and the requirement to use the BeaconLBS system before they can order any of 80 designated lab tests.
The response of the Florida
CEO SUMMARY: To date, a bill to restrict how health insurers use lab benefit management systems such as UnitedHealthcare’s BeaconLBS, has been favorably received in the Florida Senate. But the bill may face opposition when presented to the Senate’s Appropriations Committee. In a report, the state Office of Insurance Regulation said that restricting the use
CEO SUMMARY: During 2015, two stories captured the full attention of most pathologists and clinical lab managers. One was how CMS intends to gather lab price market data as mandated by PAMA. The other was the continued efforts by the FDA to move ahead on proposed guidance for regulation of LDTs. However, the full list
CEO SUMMARY: Soon, the nation’s newest laboratory benefit management company will begin working for Blue Cross Blue Shield of South Carolina. Avalon Healthcare Solutions committed to BCBSSC that it can save money off what the health plan has been spending on clinical lab testing. It will do so with algorithms supported by evidence-based medicine, good
CEO SUMMARY: Physicians in Florida continue to express significant concerns about UnitedHealthcare’s pilot program requiring pre-notification for 80 clinical laboratory tests, including many routine tests, and pre-authorization for two genetic tests. The pro- gram is so onerous that some physicians have said they want to get out of their United contracts. Moreover, during a recent webinar to show Florida physicians how the BeaconLBS system works, officials from BeaconLBS could not get the system to function!
ANSWERS TO QUESTIONS SUBMITTED to UnitedHealthcare about the insurer’s laboratory benefit management program now coming into operation in Florida were provided by the company’s public communication officer. These answers are reproduced below:
Q: Will BeaconLBS process the claims that come through the BeaconLBS system or will UHC process those claims once they are approved by BeaconLBS?