Genetic testing is one of the fastest growing areas of healthcare.

Is your genetic testing spend optimized?

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The Challenge

Genetic testing has exploded in frequency, cost and complexity. More than 60,000 unique genetic testing products exist on the market. On average, 8-10 new genetic testing products enter the market every day.

Health plans are left trying to manage the rising costs. However, even basic analytics are difficult because:

14,000+ types of genetic tests are represented by less than 200 procedural billing codes

Key Questions

With such poor data resolution, it's almost impossible for health plans to determine:

  1. What tests are we reimbursing?
  2. What are market prices?
  3. Are our medical policies aligned with our clinical philosophies?
  4. Are we receiving claims that involve coding inaccuracy or inconsistency?
  5. How do we keep up with the rapid pace of change to deliver the best for our members?

NextGxDx Deciphers the Code

We translate raw claims data into actionable information about paid claims, list prices and market rates for genetic testing products.


The Solution

Only GenePayer can address these questions, because it is the only solution that leverages a comprehensive database of 60,000+ genetic testing products to match raw claims to specific testing products, and to categorize them in clinically relevant categories.

We deliver valuable insights in four key areas:

Test & Lab Reporting

  • Match claims to genetic testing products within clinically relevant bins for comparison
  • Assess variation in pricing and payments
  • Trends in your data and market data

Payment Integrity

  • Paid claims, list price and market rates for testing products
  • Data on CPT code usage and cost information
  • Claims that may involve inaccuracy or inconsistency

Medical Policy Support

  • Gaps in policies
  • Medical policies being inappropriately applied
  • Circumstances where policies don't align with clinical philosophies

Market Intelligence

  • New testing products entering the market and projected impact
  • Forecast growth areas in the overall market
  • Trends in your data

Technology Delivery

All of this is delivered through an interactive, SaaS-based analytics and reporting platform so your team can dig further into the data to unearth insights. In addition, we deliver an expert assessment to identify top opportunities for improvement, and provide ongoing reports and support.

Thanks, we will be in contact soon!