We’re dedicated to coordinating coverage guidelines and policies for genetic testing to enhance population health outcomes, ensure positive care experiences and offer affordable products. By collaborating with you, we can provide access to promising new treatments in this emerging field, helping create a balance between patient safety and clinical evidence.
Ordering care providers can complete the prior authorization/advance notification process online or by phone. Laboratories must register their tests in the UnitedHealthcare Genetic Test Registry to participate as part of the genetic and molecular testing prior authorization/advance notification process.
To submit and manage your prior authorizations, please sign in to the UnitedHealthcare Provider Portal.
We offer live training sessions for the genetic and molecular testing prior authorization/advance notification program at 10 a.m. CT on the third Thursday of every other month.
For the current list of product-specific genetic and molecular testing prior authorization/advance notification requirements, visit our Advance Notification and Plan Requirement Resources page.
UnitedHealthcare commercial plans: Prior authorization/advance notification for genetic and molecular testing performed in outpatient settings is a requirement for the following UnitedHealthcare commercial benefit plans where UnitedHealthcare is the primary payer. Effective dates are as follows:
UnitedHealthcare Individual Exchange plans: We require prior authorization/advance notification for genetic and molecular testing performed in outpatient settings.
UnitedHealthcare Community Plan: We require prior authorization/advance notification for genetic and molecular testing performed in outpatient settings for UnitedHealthcare Community Plans in certain states, effective:
UnitedHealthcare® Medicare Advantage: We don’t require prior authorization/advance notification for genetic and molecular testing for these plans (this includes Dual Special Needs Plans).
Other benefit plans may have plan-specific prior authorization/advance notification requirements for genetic and molecular tests.
If you have questions about the prior authorization/advance notification process or want to complete prior authorization/advance notification by phone, call 877-303-7736, 7 a.m.–7 p.m. CT, Monday–Friday.