Prior Authorization Software Facilitates Broader Access to Genomic Testing
Fairfax, Virginia — Expanding its portfolio of innovative health solutions, the Inova Personalized Health Accelerator (IPHA) has invested in a new software system designed to optimize and automate the workflow involved with prior authorizations (PAs). CoverMyTest is the only PA service provider solely focused on assisting laboratories offering genetic and genomic testing. This PA software comes at a critical time in the advancement of precision medicine, with an average of eight to 10 new genetic and molecular diagnostics tests introduced every day.
The Journal of the American Board of Family Medicine calculates that the time spent figuring out insurance coverage for genetic and molecular testing costs a physician between $2,000 to over $3,000 annually, just for time alone. “New rules requiring care providers and labs to complete the PA process have created a substantial administrative and financial burden for many genetic and molecular diagnostics,” said CoverMyTest co-founder Andrew Mignatti. “Our solution reduces that burden, increases reimbursements and frees clinicians to focus on providing care.”
The CoverMyTest web-based platform provides a hub-service model that determines when a PA is required, conducts patient eligibility checks and delivers electronic PAs for physicians. The platform also provides insurance verification, documentation gathering, PA submission, and deductible management functions.
CoverMyTest has the potential to immediately boost efficiency as Inova advances its precision medicine capabilities. Inova Health System orders thousands of genetic and molecular diagnostics tests each year, driven largely by abdominal transplant, oncology, high-risk pregnancy and genomics activities.
“We have firsthand experience with the challenges and burdens of the PA process,” said Rick Gordon, IPHA Director. “And we’re certainly not alone. Hundreds of molecular labs across the United States and thousands of physicians are seeking a simpler, lab-focused solution to expedite care for their patients.”
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About Inova Personalized Health Accelerator
The Inova Personalized Health Accelerator is a unique program that provides healthcare technology and services entrepreneurs with C-suite coaches, customized plans, early stage capital, connections to strategic partners and later stage capital, and connections to customers. This bespoke approach to accelerating new companies through the early stages of product design, capital formation and commercialization will serve as the foundation for a stronger healthcare ecosystem in the mid-Atlantic region. Read more at www.inovapha.org.
Inova is a global leader in personalized health, which leverages precision medicine to predict, prevent and treat disease, enabling individuals to live longer, healthier lives. At Inova, we serve more than 2 million people each year from throughout the Washington, DC, metro area and beyond. We are shaping the future of health through our integrated network of hospitals, primary and specialty care practices, emergency and urgent care centers, outpatient services and destination institutes. Inova is home to world-class researchers, expert medical specialists and renowned scientists who are driving innovation to improve patient care, prevent disease and promote wellness. Our commitment to health and wellness is further reflected in our sustainable practices. For more information, visit www.inova.org, or find Inova on Facebook, Twitter and LinkedIn.
About CoverMyTest (CMT)
CMT provides comprehensive market access services to the full array of participants in the molecular diagnostics arena, including patients, providers, laboratories, payors and IVD diagnostic manufacturers. CMT leverages the market’s emerging need for prior authorization (PA) solutions that has arisen from the growing number of payors that require PAs.
As a result of this requirement, an entirely new business platform, now known as a “Hub Services Model” or “Market Access Program,” arose. Seizing on this opportunity, CMT’s founders and management team C-level and board member experts with deep and broad experience throughout the spectrum of the laboratory industry—responded quickly and effectively.
CMT constructed its programs to parallel the best practices established over the past 20 years from the Hub Services Model that has been instrumental in the success of pharmaceutical manufacturers. CMT now occupies the unique position of offering comprehensive services to the entire laboratory industry. CMT successfully implemented its model for patients, providers and laboratories in early 2018.
In addition to providing PA services, CMT will be able to aggregate industry-wide data on ordering trends, including success rates, denial rates and reasons for denial. This data will be generated from all insurance companies that require PAs and all laboratory providers of molecular diagnostic tests. CMT will build the only agnostic database for genetic and genomic testing in the U.S.