GeneDx Holdings Corp. (NASDAQ:WGS) Q3 2023 Earnings Call Transcript

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So I’m encouraged by some wins like that, that ensure that, that product is being utilized. The vast majority of the inpatient is institutional pay. So that’s obviously one barrier that we have removed both for utilization and also for us. We get paid 100% of the time on those. So we really appreciate that business. But we continue to view that as being a longer pull in terms of driving utilization. That’s going to take some more time. So as we think about the breakdown over the next several years, we’re still going to see it predominantly in that outpatient setting.

Prashant Kota: Got it. Thank you. And then can you just talk about your progress in reducing claim denials and specifically, what percent of claims are not approved if you have that number? And roughly how long is the appeals process?

Kevin Feeley: Yes. So as we talked about, we did bring in a bunch of new folks really to take a look at our end-to-end processes, in particular on the front end of claims submission. So a lot of work is ongoing, and we did see an uptick in ASPs. That’s all driven by a slight reduction in the denial rate this quarter. So pleased with the initial finding, certainly a long way to go there. I think it was just important to get fresh eyes on our processes. And we really feel confident that much of the denials are addressable. To your question, north of 60%. So low 60s is our denial rate today on the exome portfolio. That hasn’t changed in a while, although we did improve about 1 percentage point in the third quarter versus the second, and that’s what drove the incremental uptick in average ASPs. I think longer term, you should expect us to take incremental bites out of that denial rate with each passing quarter as the effects of the ongoing work begins to take hold.

The appeal process themselves — itself is lengthy with really us going back to payers to re-adjudicate claims based on the medical necessity and unique circumstances of patients. We have an appeal process stood up today, but I think more important to driving down denials and improving ASPs and therefore, revenue comes from avoiding denied claims, and that’s where all of our effort is focused at the moment.

Prashant Kota: Got it. That makes sense. And if I could squeeze one last one in. How are you thinking about capital allocation given the new capital you’ve raised with the debt agreement?

Kevin Feeley: Yes. I think we — the way we look at the new debt agreement is to couple it with the cost reduction actions that we took today, which, as I mentioned, the reductions really placing an emphasis on three main priorities for the company. How do we drive exome growth? How do we improve exome reimbursement by reducing denials and then how do we find cost efficiency and reduce costs elsewhere to improve the financial health of GeneDx to meet that commitment to become profitable sustainably in 2025 and beyond. And so all of our available capital is allocated to supporting those three pursuits with any capital allocated to R&D and product and technology to find ways to help the company get more efficient to drive down exome costs.

Prashant Kota: Okay. Thank you.

Operator: Thank you. And that will conclude Q&A for today. I would now like to turn the conference back to Katherine Stueland for any closing remarks.

Katherine Stueland: Great. Thank you. We have a strong and growing business, a commitment from the management team to continue to do it as efficiently as possible. And we are grateful for the continued support of our shareholders and look forward to seeing many of you at an upcoming conference. Thank you.

Operator: And this concludes today’s conference call. Thank you for participating. You may now disconnect. Everyone, have a great day.

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