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):

  • UnitedHealthcare exchange plans
  • Certain UnitedHealthcare commercial benefit plans, when UnitedHealthcare is the primary payer
  • Oxford Health Insurance 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 genetic and molecular tests that require prior authorization/advance notification, please go to UHCprovider.com/paan > Advance Notification and Plan Requirement Resources.

Please refer to the Updated Notice of Changes to Plan Requirements for 2022 to review the product-specific prior authorization/advance notification requirements.

Commercial benefit plans: Prior authorization/advance notification for genetic and molecular tests has been required for certain UnitedHealthcare commercial benefit plans since:

  • Nov. 1, 2017, for UnitedHealthcare of the Mid-Atlantic, Inc. benefit plan members 
  • 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.

Community Plans: Prior authorization/advance notification for genetic and molecular testing performed in an outpatient setting is required for UnitedHealthcare Community Plan members in these states:

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

Tests not requiring prior authorization/advance notification

The genetic and molecular testing prior authorization/advance notification requirement does not apply to members in the following types of UnitedHealthcare and affiliate health plans:

  • UnitedHealthcare Medicare and Medicare Advantage plans, including Dual Special Needs Plans (D-SNP)
  • These specific commercial plans:
    • Bind
    • Empire
    • Golden Rule Insurance Company
    • Government Employees Health Association (GEHA)
    • Harvard Pilgrim
    • MAMSI Life and Health Insurance Company
    • MD-Individual Practice Association, Inc.
    • Medica Healthcare
    • Optimum Choice, Inc.
    • PacifiCare Life and Health Insurance Company
    • Preferred Care Partners of Florida
    • Railroad
    • Sierra Health and Life Insurance Company, Inc.
    • UMR
    • UnitedHealthcare West
    • UnitedHealthOne

Even though they’re not included in the standard prior authorization/advance notification process, the listed plans may still require prior authorization for certain genetic and molecular tests. You can find plan-specific prior authorization 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.