OREANDA-NEWS. June 17, 2016. Fallon Health, a leading not-for-profit healthcare services organization based in Worcester, Mass., has selected the McKesson Diagnostics Exchange to help better manage its molecular diagnostics program.

Fallon joins four other commercial health plans and six Medicare Administrative Contractors (MACs) spanning 25 states, who are leveraging the McKesson Diagnostics Exchange to streamline management and payment of molecular diagnostic testing. Fallon Health will use the Diagnostics Exchange’s unique identification system to help them understand exactly what test is being ordered, performed and billed. This system uses McKesson Z-CodesTM —which are like UPC bar codes for MDx tests—to uniquely identify each molecular diagnostics (MDx) test.

Without McKesson Z-Code™ Identifiers, payers may struggle to understand what they’re paying for, because CPT codes are not test specific. Now, having solved the test identification challenge, Fallon Health can focus more resources on coverage and payment decisions, which helps them reduce MDx program administrative costs, better manage medical spend, and accelerate authorizations and claims adjudication.

With the McKesson Diagnostics Exchange, labs enter test information into its national catalog and are issued a unique Z-Code Identifier. Payers, labs, and physicians can then collaborate through the Exchange to view information about the tests, and payers can clearly communicate coverage policy by line of business.

“We believe the McKesson Diagnostics Exchange helps us enhance our stewardship of our members’ health and further improve relations with our laboratory network,” said Pam Cardaci, RN, senior director of integrated UM and case management at Fallon Health. “There are thousands of molecular tests and their numbers keep growing. The Exchange makes it easy for us to collaborate with labs, to get the clarity we need to best manage our MDx program, and to help ensure our members receive the right test at the right time.”

Founded in 1977, Fallon Health is a leading health care services organization. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, Fallon excels in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit http://www.fallonhealth.org.

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