New capability expands the platform’s intelligence into one of healthcare’s fastest-growing and most clinically complex specialties.

DALLAS & PALO ALTO, Calif.: Machinify today announced a new genetic testing capability, extending the platform’s intelligence into one of healthcare’s fastest-growing and most clinically complex specialties. The expansion represents another step in applying Machinify’s AI to increasingly sophisticated healthcare payment decisions, helping health plans address areas that have outpaced traditional payment integrity approaches.

Genetic testing represents one of the fastest-growing and most clinically nuanced areas of healthcare, with more than 150,000 tests on the market today and more than 10 new ones introduced daily. The pace of innovation, combined with evolving evidence, coding structures, payer policies, and coverage requirements, makes the category particularly difficult to manage at scale.

The capability builds on Machinify’s acquisition of InformedDNA’s genetic testing payment integrity business, encoding decades of specialized genetic testing review expertise directly into the Machinify platform. By combining AI with deep clinical expertise, Machinify enables health plans to make more informed decisions throughout the payment lifecycle, whether preventing incorrect payments before they occur or identifying overpayments downstream.

“Precision medicine is generating more clinical complexity than any human review organization can keep up with, and genetic testing is the sharp edge of that,” said David Pierre, CEO of Machinify. “We didn’t build a genetic testing tool. We taught our AI to reason about genetic testing the same way it already reasons about the rest of the claim, with deep human expertise built in. That’s the whole idea behind Machinify: as healthcare gets more complex, machine intelligence keeps the lead because every decision makes the next one smarter. That’s how we bend the cost curve.”

The platform applies a specialized genetic testing knowledge base alongside each payer’s medical policies to evaluate claims within their full clinical and contractual context. Grounded in Machinify’s experience supporting Medicare, Medicaid, and commercial health plans, the models are developed, validated, and continuously governed by the company’s board-certified geneticists and clinical experts. Every determination is transparent, defensible, and fully auditable.

The approach is already delivering measurable results. In one Medicaid program, the capability identified more than $70 million in savings across reproductive and pharmacogenomic testing while improving the accuracy of payments for these services going forward.

“Specialty areas like genetic testing are more important than ever; the science is evolving daily, and the spend has accelerated dramatically,” said Tom Magnotta, President of Complex Payment Solutions at Machinify. “We are actively investing in and expanding our content on the platform. Genetic testing is just one of many areas where Machinify is deploying solutions to solve complex challenges for our clients using an AI-first approach.”

The genetic testing solution is available now to Machinify clients through the platform’s real-time pre-payment solution or as a post-payment extension where retrospective recovery is required.

About Machinify

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence. For more information about Machinify and its partners, visit www.machinify.com.

Fonte: Business Wire