Knowledge Base
Practical guides on prior authorization, denials, and reimbursement — written for genetic labs and oncology revenue cycle teams.
Fundamentals
What's Actually Covered as "Preventive" Under the ACA
The ACA's $0 preventive coverage is real. So are the four conditions that have to hold for it to apply. What's covered, what gets billed, and how to appeal.
Read article →The Five Health Insurance Plan Types Explained
HMO, PPO, HDHP, POS, EPO. What each plan type controls about your bill, with KFF 2025 enrollment data and a side-by-side comparison.
Read article →Modifier 25 Explained: Why Your "Free" Checkup Got a Bill
Modifier 25 is the code that turns a no-cost preventive visit into a billed one. When it is appropriate, when it is questionable, and how to appeal.
Read article →What Is Prior Authorization? A Practical Guide for Genetic Labs and Oncology RCM Teams
Prior authorization is a payer requirement that providers obtain advance approval before delivering certain services, drugs, or tests — and understanding its mechanics is essential for minimizing delays and denials in genetic testing and oncology.
Read article →Denials
Denials 101: A Taxonomy of Denial Reasons and How to Escalate Each
Not all denials are equal — understanding the specific reason code behind a denial determines which escalation pathway gives you the best odds of reversal, especially for genetic testing and oncology claims.
Read article →The 7 Most Common Claim Denial Reasons (and How to Fix Each)
Seven denial types cover the vast majority of claim rejections in genetic testing and oncology — here's the fix for each, not a general appeals strategy.
Read article →Payer Playbooks
eviCore Guidelines for Oncology: What Practices Need to Know in 2026
eviCore manages oncology PA reviews for Cigna, Aetna, BCBS affiliates, and UHC Medicare Advantage — and their clinical pathways are different enough from standard payer policies that practices need a separate playbook.
Read article →UnitedHealthcare Prior Authorization Requirements: A 2026 Guide for Specialty Practices
UnitedHealthcare's PA requirements for specialty labs and oncology have expanded significantly — here's how to navigate their portals, policies, and timelines without burning your staff.
Read article →Genetic Testing
Reimbursement
Gold Carding: What It Is, Which Payers Offer It, and How to Qualify
Gold carding is a payer program that exempts high-performing providers from prior authorization requirements for specific services — and for genetic labs and oncology practices with strong approval track records, it can eliminate weeks of administrative friction.
Read article →Lab Billing 101: CPT, MAAA, and Z-Codes for Molecular Diagnostics
Molecular lab billing uses CPT Tier 1, Tier 2, MAAA codes, and DEX Z-codes — and choosing the wrong one gets your claim denied before a human ever reads it.
Read article →Appeals
How to Write a Prior Authorization Appeal Letter That Actually Works
A PA appeal letter fails or succeeds based on how directly it addresses the denial reason — here's how to structure one that payers actually reverse.
Read article →Peer-to-Peer Reviews: How to Win Them
A peer-to-peer review is your best shot at reversing a medical necessity denial before you spend weeks on a written appeal — here's how to prepare for and run one.
Read article →Step Therapy Override Appeals: When and How to File
Step therapy requirements block specialty drug access when a payer says you must try a cheaper option first — but override rights are real, and so is the legal framework behind them.
Read article →