BCBS of Illinois is the largest PPO network in the state, covering roughly 7.9 million people.
A PLUGS collaboration with EviCore resulted in the lab benefit manager creating a policy for covering whole-exome sequencing.
An assessment concluded that Oncotype Dx has not demonstrated a significant enough impact on outcomes or cost effectiveness compared to current practice.
The test was developed by the University of Pittsburgh Medical Center and is marketed in partnership with Sonic Healthcare.
Several of the top molecular diagnostic firms presented at the JP Morgan Healthcare Conference on Monday discussing product portfolios, FDA clearances, and plans for 2018.
The coverage decision is based on the results of an evidence development study the companies launched last year.
The court's modified ruling allows laboratories to rely on an ordering physician's determination of medical necessity.
Some industry players are accusing CMS of advancing backdoor LDT regulation by proposing to cover NGS tests with FDA approval/clearance, except in a limited setting.
The carrier helps diagnostic companies to defray evidence development costs by covering experimental diagnostics on a trial basis.
This is Biocept's third BCBS contract and enables cancer patients to access the company's testing services in network under their Wellmark health plans.
ACLA alleges that HHS and CMS interpreted the Protecting Access to Medicare Act in a way that resulted in 2018 payment rates that are much lower than Congress intended.
AdvaMed's VP of payment and healthcare delivery policy said that the framework promotes a broad definition and understanding of value.
The suit filed against the acting HHS secretary alleges that a flawed data collection process failed to establish market-based rates.
The investment bank said that an edit to CMS guidelines impacts payments for hereditary cancer testing, and could present Myriad with revenue and EPS headwinds.
The final guidance is an update to an agreement between the FDA and CMS, which uses the FDA's policy in determining coverage for investigational devices.
Payors' demands for clinical utility evidence can be met through greater use of databases and registries, Harold Varmus and Rebecca Eisenberg said.
Lipid panel prices and prices for tests formerly bundled together as automated testing profiles are expected to rise in 2018, but fall in 2019.
The government payor made some adjustments in finalizing the 2018 clinical lab fee schedule, but the industry continues to feel CMS is ignoring its most salient concerns.
The US Attorney's Office, District of New Jersey said the cardiologist and his wife operated a test-referral bribery scheme with Biodiagnostic Laboratory Services
Ahmed El Soury was sentenced for his role in a scheme perpetrated by now-defunct Biodiagnostic Laboratory Services to bribe doctors in return for testing referrals.