Multi-CPT panel submissions. MolDX technical assessments. Somatic vs germline coverage rules. Panel-by-panel payer policies. Converus handles every layer — and applies federal mandate overrides automatically when a payer's policy contradicts them.
Generic PA automation breaks on genetic testing because it treats all cases the same. Converus knows the difference between a BRCA panel under MolDX and a solid tumor profiling test under a commercial payer's LCD.
MolDX coverage determinations, LCD-specific documentation requirements, panel coverage variability by payer, and biomarker-level criteria — all structured in the Converus knowledge graph and continuously updated as policies change.
Converus assembles clinical evidence from NCCN, ASCO, and payer-specific criteria — pulling the right documentation for this test, this indication, this payer. Not a generic template. A case built from clinical reasoning.
The system flags weak-evidence cases pre-flight — before the PA goes out. Missing a molecular test result that the payer requires? Somatic-vs-germline distinction not documented? You know before it costs you an authorization.
MolDX coverage varies by contractor jurisdiction. Converus maps the correct LCD for each case, assembles the required clinical documentation, and catches missing family history or NCCN criteria before submission.
Somatic panel PAs require documented tumor type, treatment decision intent, and biomarker rationale. Converus pulls the relevant pathology data, maps it to payer-specific requirements, and builds the case automatically.
Multi-gene panel PAs hinge on clinical utility documentation and prior test history. Converus handles the evidence assembly and ensures somatic-vs-germline context is correctly documented for each payer.
PGx coverage is highly variable by payer and indication. Converus tracks which payers cover which PGx tests under what clinical circumstances, and builds the documentation to match — no manual policy research required.
Your first 50 cases are on us — your actual payer mix, your panels, your denial patterns. See the results before you commit to anything.
First 50 cases free · No commitment · Your payer mix and specialty