About the program
The Routine Lab Testing program addresses the expanding world of laboratory testing and its associated complexities by matching the clinical appropriateness of test ordering and network management. Our solution makes ordering the appropriate test from the right lab a priority and reduces overutilization and inappropriate ordering of high volume/low unit price tests.
Our solution ensures that:
- Labs meet quality standards appropriate to the complexity of the test
- There is transparency between what providers order and what the lab bills
- Evidence-based guidelines available to the provider at the point of order
- The right test is selected for the right facility/location
- With our integrated EHR solution, the program requirements are handled within the physician’s normal workflow
The Routine Lab Testing program will begin in 2025 and rolled out in phases. It will begin with claim edits and lab quality measures to ensure that labs have the expertise needed to appropriately handle the complexity of tests they offer. Then later, with EHR integration, the program can be handled as part of the normal lab test ordering workflow.
Note: Prior authorization for genetic tests will continue as it does today. Laboratories billing for genetic testing should continue to submit their genetic test compendiums to Carelon. For more information on the Genetic Testing program, click here.