Search

Genetic and molecular testing prior authorization/advance notification

We’re committed to working with consumers and care providers to support improved population health outcomes, positive care experiences and affordable products. An increasingly important part of this commitment includes coordinating coverage guidelines and policies for new and emerging technologies, including genetic testing.

By working with you, we can provide access to this emerging field and promising new treatments for patients, while balancing patient safety and clinical evidence. Our prior authorization/advance notification process for genetic and molecular tests provides access and supports a positive experience for members and care providers.

The prior authorization/advance notification requirement for certain genetic and molecular tests applies to (see specific plan details below):

  • Certain UnitedHealthcare commercial benefit plans when UnitedHealthcare is the primary payer, including Oxford Health Insurance plans
  • UnitedHealthcare exchange plans
  • UnitedHealthcare Community Plans in select states

Ordering care providers can complete the prior authorization/advance notification process online or over the phone. Laboratories must register their tests to participate as part of the genetic and molecular testing prior authorization/advance notification process.

Prior authorization/advance notification training

UnitedHealthcare offers 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 month.

Tests requiring prior authorization/advance notification

For the current list of product-specific genetic and molecular testing prior authorization/advance notification requirements go to UHCprovider.com/paan > Advance Notification and Plan Requirement Resources.

Commercial benefit plans: Prior authorization/advance notification for genetic and molecular testing performed in an outpatient setting has been required for the following UnitedHealthcare commercial benefit plan members since:

  • Nov. 1, 2017, for UnitedHealthcare of the Mid-Atlantic, Inc.
  • April 1, 2018, for UnitedHealthcare Plan of the River Valley, Inc. and UnitedHealthcare Insurance Company of the River Valley
  • July 1, 2019, for Oxford Health Insurance, Inc. 
  • April 1, 2020, for All Savers Insurance Company and All Savers Life Insurance Company of California 
  • Sept. 1, 2020, for UnitedHealthcare exchange plans
  • Jan. 1, 2021, for Neighborhood Health Partnership, Inc.

Exchange plans: Prior authorization/advance notification for genetic and molecular testing performed in an outpatient setting is required.

Community plans: Prior authorization/advance notification for genetic and molecular testing performed in an outpatient setting has been required for UnitedHealthcare Community Plan members in these states since:

  • Feb. 1, 2019: Maryland, Michigan, Missouri, New York, Tennessee, Texas
  • March 1, 2019: Florida
  • April 1, 2019: New Jersey, Rhode Island
  • Feb. 1, 2020: Pennsylvania
  • May 1, 2020: Virginia
  • July 1, 2020: Hawaii, Wisconsin
  • Sept. 1, 2020: Washington
  • Nov. 1, 2020: Ohio
  • Dec. 1, 2020: Kansas
  • Jan. 1, 2021: Kentucky
  • July 1, 2021: North Carolina
  • Oct. 1, 2021: Mississippi
  • Jan. 1, 2022: Minnesota

Medicare Plans: Prior authorization/advance notification for genetic and molecular testing is not required for UnitedHealthcare Medicare and Medicare Advantage plans, including Dual Special Needs Plans (D-SNP).

For plans not listed above, there may be plan-specific prior authorization/advance notification requirements for certain genetic and molecular tests. You can find the plan-specific requirements in our medical policies and prior authorization lists.

Frequently asked questions (FAQ)

Need help?

If you have questions about the prior authorization/advance notification process, about using the online process, or want to complete the prior authorization/advance notification process over the phone, call us at 877-303-7736. Representatives are available Monday–Friday, 7 a.m.–7 p.m. CT.