Effective July 1, 2020, for UnitedHealthcare Community Plan members in California, Hawaii, Ohio* and Wisconsin, we will require prior authorization and notification for genetic and molecular testing performed in an outpatient setting.
How It Works:
Use the Genetic and Molecular Lab Test tool on Link to submit your request.
Fill in the member’s information.
Choose the test and lab to perform the test.
Ordering care providers — Submit requests for tests that require authorization.
Labs — Submit your own notification requests for tests that only require notification.
You’ll get a decision right away if your online request meets UnitedHealthcare’s clinical and coverage guidelines.**
If more information or clinical documentation is needed, we’ll contact you.
Approval Will Be Required for the Following:
Tier 1 Molecular Pathology Procedures
Tier 2 Molecular Pathology Procedures
Genomic Sequencing Procedures
Multianalyte Assays with Algorithmic Analyses that include Molecular Pathology Testing
* For Ohio this change has been delayed until July 1, 2020, not June 1, 2020 as previously announced in the March 2020 Network Bulletin.
** Determinations for notification/prior authorization requests will be made based on UnitedHealthcare’s clinical policy requirements for coverage. Our clinical policies can be found at UHCprovider.com/policies.