Payer Adjudication Automation

Unlock Efficiency Adjudicating Genetic Test Claims

Gistia PayerIQ™ revolutionizes how Healthcare Payers manage prior-authorization, processing, and payment for genetic test claims.

Gistia Healthcare is trusted by industry leaders

Why is Genetic Test Claim Adjudication a Nightmare?

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You're overwhelmed with 75,000 genetic tests across 400 labs.
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Every month, 300 new tests enter the system, further complicating validation.
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Z-codes and CPT Codes have made manual review a frustrating, error-prone process.
You need Gistia PayerIQ™

The Automated Solution for Genetic Test Claims

Gistia PayerIQ™ brings AI-driven clarity to your genetic test claim processes.
Automated Diagnostic Matching

Validate ICD-10 Codes and Supporting Documentation

Gistia PayerIQ™ validates the physician's diagnosis code and related documentation, ensuring the genetic tests in the claim align with the patient's symptoms.
  • Automatic CPT and Z-code matching
  • Streamline the diagnostic verification process
  • Rule out incorrect biomarker submissions
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Medical Necessity

Determine if a Genetic Test is Medically Appropriate

Gistia PayerIQ™ categorizes claims into 'Accepted', 'Manual Review', and 'Rejected', based on medical appropriateness and coverage guidelines.
  • Efficiently categorize claims, reducing manual review
  • Adapt machine learning algorithms for future automation
  • Stay aligned with coverage and reimbursement guidelines
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Seamless Integration

Ready to Deploy by Year's End

Gistia PayerIQ™ integrates smoothly with your existing systems, becoming operational in no time.
  • Quick system assessment and implementation
  • High performance assured with blinded data pools
  • Meet regulatory requirements for timely, appropriate care
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Stop Manual Adjudication — Automate Genetic Test Claim Validation with Gistia PayerIQ™.

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"After our merger, Gistia integrated our lab systems, enhancing data handling and streamlining reporting. We're thrilled with the outcome and highly recommend their solutions. We look forward to a long-term partnership with Gistia."
Patrick Chase

Patrick Chase

Senior IT Director at Avero


Transform Your Genetic Test Claim Management

Accelerate your genetic test claim workflow with adjudication automation tailored to your needs.