Systems and methods relating to health policy coverage of medical products and services

1. A computer-implemented method for determining whether a health policy covers a genetic testing service or product, comprising:

receiving information that indicates a genetic testing service or product and a health policy that covers certain services or products;

determining an identifier corresponding to the genetic testing service or product based on the received information, wherein the identifier comprises a genetic testing unit (GTU) for the genetic testing service or product,

wherein the GTU is a consistent identifier for tracking a plurality of attributes of the genetic testing service or product over time, and

wherein determining the identifier comprising the GTU comprises using a machine learning model to match the identifier to the genetic testing service or product based on a training dataset;

associating the determined identifier corresponding to the genetic testing service or product with a corresponding coverage outcome algorithm (COA) from among a plurality of coverage outcome algorithms (COAs), wherein each COA has associated coverage criteria for determining a coverage outcome;

prompting, through an interactive user interface, the user with specific queries for information associated with the genetic testing service or product and/or health plan policy, wherein the queries are based on the respective coverage criteria corresponding to the COA;

receiving user responses to the queries through the interactive user interface;

determining, based on the user responses, a coverage outcome indicating whether the health policy covers the genetic testing service or product; and

outputting the coverage outcome to the user.

2. The method of claim 1 , wherein the COAs utilize triggers associated with the genetic testing service or product.

3. The method of claim 1 , wherein the identifier further comprises a categorical bin associated with the genetic testing service or product.

4. The method of claim 1 , wherein the identifier correspond to a claim for coverage for the genetic testing service or product.

5. The method of claim 1 , wherein at least some of the queries are customized according to the identity of the user as a patient, health care provider, or health policy representative.

6. The method of claim 2 , further comprising:

based on at least one of the triggers, determining whether there is a predetermined coverage outcome corresponding to the genetic testing service or product; and

responsive to determining that there is a predetermined coverage outcome, outputting the predetermined coverage outcome to the user.

7. The method of claim 1 , wherein the GTU's plurality of attributes of the genetic testing service or product tracked over time comprise one or more of: test code; target gene; time-to-results; and laboratory code.

8. A system, comprising:

one or more processors;

an interactive user interface;

a memory device coupled to the one or more processors and storing instructions that, when executed by the one or more processors, cause the system to perform functions for determining whether a health policy covers a genetic testing service or product, and wherein the performed functions comprise:

receiving information that indicates a genetic testing service or product and a health policy that covers certain services or products;

determining an identifier corresponding to the genetic testing service or product based on the received information, wherein the identifier comprises a genetic testing unit (GTU) for the genetic testing service or product,

wherein the GTU is a consistent identifier for tracking a plurality of attributes of the genetic testing service or product over time, and

wherein determining the identifier comprising the GTU comprises using a machine learning model to match the identifier to the genetic testing service or product based on a training dataset;

associating the determined identifier corresponding to the genetic testing service or product with a corresponding coverage outcome algorithm (COA) from among a plurality of coverage outcome algorithms (COAs), wherein each COA has associated coverage criteria for determining a coverage outcome;

prompting, through the interactive user interface, the user with specific queries for information associated with the genetic testing service or product and/or health plan policy, wherein the queries are based on the respective coverage criteria corresponding to the COA;

receiving user responses to the queries through the interactive user interface;

determining, based on the user responses, a coverage outcome indicating whether the health policy covers the genetic testing service or product; and

outputting the coverage outcome to the user.

9. The system of claim 8 , wherein the COAs utilize triggers associated with the genetic testing service or product.

10. The system of claim 8 , wherein the identifier further comprise a categorical bin associated with the genetic testing service or product.

11. The system of claim 8 , wherein the identifier correspond to a claim for coverage for the genetic testing service or product.

12. The system of claim 8 , wherein at least some of the queries are customized according to the identity of the user as a patient, health care provider, or health policy representative.

13. The system of claim 9 , wherein the memory device stores further instructions that, when executed by the one or more processors, cause the system to:

determine, based on at least one of the triggers, whether there is a predetermined coverage outcome corresponding to the genetic testing service or product; and

responsive to determining that there is a predetermined coverage outcome, outputting the predetermined coverage outcome to the user.

14. A non-transitory computer-readable medium storing instructions that, when executed by one or more processors, cause one or more computing devices to perform functions for determining whether a health policy covers a genetic testing service or product, and wherein the performed functions comprise:

receiving information that indicates a genetic testing service or product and a health policy that covers certain services or products;

determining an identifier corresponding to the genetic testing service or product based on the received information, wherein the identifier comprises a genetic testing unit (GTU) for the genetic testing service or product,

wherein the GTU is a consistent identifier for tracking a plurality of attributes of the genetic testing service or product over time, and

wherein determining the identifier comprising the GTU comprises using a machine learning model to match the identifier to the genetic testing service or product based on a training dataset;

associating the determined identifier corresponding to the genetic testing service or product with a corresponding coverage outcome algorithm (COA) from among a plurality of coverage outcome algorithms (COAs), wherein each COA has associated coverage criteria for determining a coverage outcome;

prompting, through an interactive user interface, the user with specific queries for information associated with the genetic testing service or product and/or health plan policy, wherein the queries are based on the respective coverage criteria corresponding to the COA;

receiving user responses to the queries through the interactive user interface;

determining, based on the user responses, a coverage outcome indicating whether the health policy covers the genetic testing service or product; and

outputting the coverage outcome to the user.

15. The computer-readable medium of claim 14 , wherein the COAs utilize triggers associated with the genetic testing service or product.

16. The computer-readable medium of claim 14 , wherein the identifier further comprises a categorical bin associated with the genetic testing service or product.

17. The computer-readable medium of claim 14 , wherein the identifier corresponds to a claim for coverage for the genetic testing service or product.

18. The computer-readable medium of claim 14 , wherein at least some of the queries are customized according to the identity of the user as a patient, health care provider, or health policy representative.

19. The computer-readable medium of claim 15 , further comprising:

based on at least one of the triggers, determining whether there is a predetermined coverage outcome corresponding to the genetic testing service or product; and

responsive to determining that there is a predetermined coverage outcome, outputting the predetermined coverage outcome to the user.

20. The computer-readable medium of claim 14 , wherein the GTU's plurality of attributes of the genetic testing service or product tracked over time comprise one or more of: test code; target gene; time-to-results; and laboratory code.