System and method for laboratory-based authorization of genetic testing

1. A system for laboratory-based authorization for genetic based medication efficacy testing, said system comprising:

a number of healthcare provider systems, each comprising an electronic health record (“EHR”) system comprising diagnoses and active medications for a number of patients;

a laboratory system comprising a laboratory information system (“LIS”) in electronic communication with each of the number of healthcare provider systems and the respective EHR systems and genetic sequencing devices in electronic communication with the LIS, wherein said LIS comprises an automated pre-approval request engine;

a database in electronic communication with the LIS comprising medications known to be wholly or partially ineffective in persons having particular genetic markers;

a prior authorization provider system in electronic communication with the LIS;

a call center system in electronic communication with the LIS; and

a payment processing system in electronic communication with the call center system;

wherein said automated pre-approval request engine is configured to, for each of a number of received electronic HL7 orders:

query the EHR associated with an ordering one of the healthcare provider systems to retrieve active medications and diagnoses associated with a patient identifier provided in the respective electronic HL7 order;

automatically parse the patient identifier, insurance policy information, and ordered testing from the respective electronic HL7 order and the diagnoses and the active medications from the EHR to generate a prior authorization request;

electronically transmit, from the LIS to the prior authorization provider, the prior authorization request;

receive, from the prior authorization provider at the LIS, a reference number and patient responsibility amount for the prior authorization request;

for each of the number of received electronic HL7 orders having a patient responsibility amount below a predetermined threshold:

instructing, by way of the LIS, one of the genetic sequencing devices to perform the ordered testing on a specimen received for the respective electronic HL7 order to determine the patient's genetic makeup;

query the database to retrieve medications known to be wholly or partially ineffective in persons having the same genetic makeup as the patient;

determine, at the LIS, if one or more of the active medications match the retrieved medications;

integrate testing results into the EHR of the healthcare provider system by flagging ineffective medications as allergies;

for each of the number of received electronic HL7 orders having a patient responsibility amount above a predetermined threshold:

transmit an encrypted email comprising patient contact information and the patient responsibility amount from the LIS to the call center system;

contact the patient contact information by way of the call center system to request payment for the patient responsibility amount;

where payment is not received from the patient, provide a notification to the LIS to destroy the specimen for the respective electronic HL7 order; and

wherein payment is received:

instructing, by way of the LIS, one of the genetic sequencing devices to perform the ordered testing on the specimen received for the respective electronic HL7 order to determine the patient's genetic makeup;

query the database to retrieve medications known to be wholly or partially ineffective in persons having the same genetic makeup as the patient;

determine, at the LIS, if one or more of the active medications match the retrieved medications; and

integrate testing results into the EHR of the healthcare provider system by flagging ineffective medications as allergies.