Starting on November 1, 2020 laboratories in Ohio and Kansas participating in United Healthcare’s (UHC) Community Plan and certain commercial plans will be subject to new prior authorization requirements for outpatient genetic and molecular testing.
The notification/prior authorization requirements for certain genetic and molecular tests applies to:
• Certain United Healthcare commercial benefit plans when UHC is the primary payer
• Oxford Health Insurance
• United Healthcare Community Plan in select states
Advance notification requests can be completed by either the lab performing the test or the ordering care provider.
Click here to view United Healthcare’s Network Bulletin. On Page 9 of the bulletin are several links that outline the current genetic and molecular tests that require prior authorization. To view Frequently Asked Questions, click here.
APS looks to provide ongoing support to our clients to help identify new carrier prior authorization requirement policies to help educate referring providers as well as their internal staffs.