Rosetta Genomics Ltd, Israel, with US headquarters in Philadelphia, has singned an agreement with Three Rivers Provider Network Inc, Chula Vista, Calif, for the Rosetta Cancer Origin Test.
Three Rivers is one of the largest supplemental Preferred Provider Organizations (PPO) in the United States, providing health care benefits to more than 10 million members nationwide.
“Together with Medicare reimbursement, the total number of covered lives and for which the Rosetta Cancer Origin Test could be adjudicated as ‘in-network’ now exceeds 61 million, which means that one-in-five Americans are covered for the Rosetta Cancer Origin Test,” says Kenneth A. Berlin, president and CEO, Rosetta Genomics. “We continue to pursue additional agreements with other PPOs as they provide faster payment while maintaining acceptable levels of reimbursement, and also reduce costs incurred through appealing denials. This has become increasingly important to our company as we continue to see a growing number of samples being processed and billed by our CLIA lab.”
This is the second credentialing agreement executed between Rosetta and a US PPO, according to Berlin.
“With more than 200,000 patients per year presenting with Cancer of Unknown or Uncertain Primary (CUP) or who would otherwise benefit from this test, this expanding coverage reflects the importance of determining the tumor origin in hard-to-diagnose metastatic cancers and CUP,” Berlin says. “This is particularly important as new, molecularly-targeted cancer treatments are developed.”
A PPO is a managed care organization of medical doctors, hospitals, and other health care providers that 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 organizations such as physicians, care facilities and ancillary providers (including testing service providers such as Rosetta Genomics’) contract directly with the PPO.
The Three Rivers network is comprised of more than 600,000 total providers, including more than 5,000 hospitals and 70,000 ancillary facilities.
[Source: Rosetta Genomics]
