Payer Resources for Providers
At Jura Health, we support clinicians navigating the clinical, documentation, and reimbursement aspects of genetic testing, including whole genome sequencing (WGS). The resources below are designed to assist providers and care teams with prior authorization, medical necessity documentation, and appeals — with the goal of reducing barriers to access and supporting appropriate use of genomic testing in patient care.
Available Templates
Request for Coverage Approval: Outpatient Diagnostic Whole Genome Sequencing (WGS).
This template can be used to provide rationale for coverage based on medical and Medicaid guidelines.
Sample Letter of Medical Necessity
A template to support providers in responding to payer requests for a letter of medical necessity.
Sample Letter of Appeal
A template to assist healthcare providers in appealing denials of coverage for genetic or genomic testing.
American College of Medical Genetics and Genomics (ACMG)
Exome and genome sequencing for pediatric patients with congenital anomalies or intellectual disability: an evidence-based clinical guideline of the American College of Medical Genetics and Genomics (ACMG)
American Academy of Pediatrics Guidelines
The American Academy of Pediatrics’ June 23, 2025 clinical report urges general pediatricians to use a genetics first approach when evaluating children with intellectual disability or global developmental delay. We recommend highlighting this when seeking authorizations and appeals, this can help educate payors on current medical standards.
Evidence review and considerations for use of first line genome sequencing to diagnose rare genetic disorders
A comprehensive evidence review shows that using genome sequencing as a first-line diagnostic test for rare genetic disorders significantly improves diagnostic yield and clinical decision-making compared with traditional stepwise testing, supporting earlier, more effective care.
Commonly Referenced Medical Guidelines
The Cost of Delayed Diagnosis in Rare Disease: A Health Economic Study
A landmark report showing the cost savings of receiving a more timely diagnosis in rare diseases. The economic impact of a delayed diagnosis is up to $517,000 in avoidable costs per patient. Shortening the more than six-year average diagnostic odyssey saves money for individuals, caregivers, and the healthcare system, while improving health outcomes.
Commonly Referenced Economic Justifications
Provider Support
If you have questions about these resources or would like support with a specific case, our team is available to help.
Email: info@jura.health
Phone: (888) 420-0507