PMPM decreased spend
*Fallon case study
Effectively Manage Your MDx Program
Precisely identify MDx tests by utilizing the proprietary DEX Z-Code™ identifier and cataloging the test information.
Reduce medical costs for unnecessary or miscoded tests.
Create transparency allowing payers to view information about the specific MDx test performed and giving labs visibility into coverage determinations.
Streamline and facilitate communications about MDx tests between payers and labs with workflow for test assessment.
Manage administrative costs by reducing the manual review of MDx claims.
Simplify claims processing for all stakeholders.
Drive Appropriate MDx Coverage and Reimbursement
Unique test identification
- MDx tests are registered by labs, verified, and assigned a DEX Z-code, Change Healthcare’s unique and proprietary identifier.
- Z-Code identifiers are unique 5-character alpha-numeric tracking codes associated with a specific MDx test with the capacity to accommodate over a million unique tests.
- When an MDx claim is submitted, it includes the associated CPT code and the Z-Code identifier is entered into the comment field of the claim.
Online test catalog
- Online national catalog of MDx tests with Z-Code identifiers assigned for unique identification. Catalog is updated as new MDx tests are registered by labs, verified, and assigned their Z-Code identifiers.
- Includes detailed information about each test in addition to the Z-Code including a test description, the labs that perform the test, clinical information like analytic specificity and sensitivity, related CPT codes, and clinical validity.
- Access additional clinical information about the test such as specimen and handling information and InterQual Clinical Evidence Summaries. The lab view of an MDx test in the catalog includes payer policy by line of business.
Policy management workflow
- Based on each payer’s specific criteria, labs can submit the appropriate material to payers for assessment. Payers can then create a new medical policy determination or apply the existing rule.
- Test assessment criteria is configurable to meet a payer’s evidence review requirements and becomes standard for all labs to use.
- Once a coverage decision is made, it is recorded, communicated to the lab, and visible to labs in the test catalog.
Providing Measurable Value
PMPM decreased spend
decrease in the time spent on prior authorizations
DEX Z-Code identifiers assigned including 2,200+ panels