PriorAuthNow's platform will be integrated with Xifin RPM 9's intelligent automation. According to Xifin, $31 billion is spent each year on prior authorizations.
The payor published positive medical policy coverage for the ThyGenX and ThyraMir assays for thyroid nodules deemed indeterminate by standard cytopathological analysis.
The final determination also adds coverage for FDA-approved tests in stage III patients, and for repeat testing if patients receive a new primary diagnosis.
The lab industry's appeal to CMS follows Missouri's Medicaid agency's reduction of lab reimbursements from 100 percent to 80 percent of Medicare rates.
Interpace said that its two thyroid tests are now covered for over 280 million patients nationwide including Medicare, Medicare Advantage, and national and regional health plans.
Although a draft guidance last month recommended against use of molecular tests to guide chemotherapy, the group's finalized decision is subject to price negotiation and other adjustments.
Executives at two commercial payors said they'd follow CMS' lead when it comes to patients covered under Medicare but beyond that their support for the agency's policy is less clear.
