We’re committed to working with consumers and health care professionals 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:
Ordering health care professionals 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.
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, 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:
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
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).
Certain other benefit plans have plan-specific prior authorization/advance notification requirements for genetic and molecular tests. You can find plan-specific requirements in our medical policies and prior authorization lists or by calling the Provider Services number on the back of the member’s ID card.
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.