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UnitedHealthcare Implementing Prior Authorization Program for Genetic, Molecular Tests

NEW YORK (GenomeWeb) – Starting Oct. 1, UnitedHealthcare is implementing a national online prior authorization program for genetic and molecular testing in the outpatient setting, the insurers said in a network bulletin.

The program applies to fully insured UnitedHealthcare commercial members. During the authorization process, clinicians requesting genetic and molecular tests for patients will need to provide the laboratory name, the name of the test, or the name of the gene to UnitedHealthcare, who will use the information, along with clinical information to determine reimbursement eligibility.

The insurer also said that starting in the second quarter of this year, labs that perform genetic and molecular testing needed to provide such details about their tests as the test name, test ID number, and codes for billing to complete authorization and "ensure correct coding and payment of claims." Upon implementation of the program, only those CPT codes that are registered with its program will be reimbursed, UnitedHealthcare added.  

Laboratory services ordered by network providers in Florida and Texas for fully insured UnitedHealthcare commercial members in those state are exempt from participation in the program because of their participation in the UnitedHealthcare Laboratory Benefit Management Program, the insurer said. 

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