Genetic Technologies (ASX: GTG, NASDAQ: GENE) has made a credentialing agreement with California-based Three Rivers Provider Network, bringing the total number of such agreements in the U.S. up to five.
Notably, it increases the total number of covered lives, for which its BREVAGen™ breast cancer risk test could be adjudicated as “in-network”, to more than 23 million.
Use of the test have been steadily increasing since its launch in July 2011 with 403 samples received in the March 2013 quarter. This along with the credentialing agreements have increased total sales revenue for the test by more than 31% over the previous corresponding period.
A review of reimbursement claims for the BREVAGen™ test since its launch has highlighted the average reimbursement currently being received per test from insurers is 25% higher when the claims are adjudicated as in-network via contracted Preferred Provider Organisations (PPOs).
In addition, the total number of days taken to collect the payment is significantly reduced when claims are processed as in-network.
Once BREVAGen™ sample volumes reach a significant level and Genetic Technologies has gathered any necessary clinical utility data, the Company will approach insurers directly to contract.
A PPO is a managed care organisation of medical doctors, hospitals and other health care providers who has covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer’s or administrator’s clients.
Credentialing is a process whereby provider organisations such as physicians, care facilities and ancillary providers contract directly with the PPO.
Credentialing contracts have now been executed with Three Rivers Provider Network, Prime Health Services, National Preferred Provider Network / PlanCare America / Ohio Preferred Provider Network LLC (NPPN / OPPN), Galaxy Health Network and Fortified Provider Network.
Genetic Technologies is now actively pursuing agreements with other PPOs in order to further extend access to an increased number of covered lives.
The company had $3.14 million in cash as of 31 March 2013.
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