Genomic testing is growing quickly, and so is the risk of inappropriate utilization, incomplete submissions and out-of-network claims. MediniPathway™ gives payers structured, complete case information at the point of authorization and keeps members in network.
What Medini does for payers?
Structured medical necessity submissions:
So reviewers receive complete, consistent documentation.
A tracked prior authorization workflow:
From submission through determination and any appeal.
In-network compliance:
Members are routed to laboratories in your network.
Case documentation designed to support accurate claims processing:
Downstream.
Utilization reporting:
Across ordering practices and test types.
Government payer rules:
Embedded in every workflow.
How a case reaches a payer?
- The physician orders a test; Medini verifies eligibility and in-network status.
- Medini prepares and submits the medical necessity documentation and prior authorization request.
- The payer reviews and issues its determination. Medini tracks it and manages any appeal.
- The in-network laboratory performs the test and submits its claim.
Collaboration opportunities (in development)
Population health initiatives, risk stratification, clinical outcomes measurement, cost optimization, and future integration.
