UnitedHealthcare (UHC) is launching an online prior authorization program for genetic and molecular testing performed in an outpatient setting for fully insured UHC Commercial Plan members.* Effective Nov. 1, 2017, participating physicians will be required to obtain prior authorization for molecular and genetic tests, selecting from a list of registered tests performed by registered laboratory facilities. Contracted by UHC to facilitate the new online notification/prior authorization process, Beacon Laboratory Benefit Solutions, Inc. (BeaconLBS) is requiring all laboratories participating in genetic and molecular testing to register their tests by September 15, 2017.
After Nov. 1, 2017, payments will only be authorized for registered genetic and molecular tests performed by registered labs where the ordering physician obtained prior authorization. To register your lab and tests for the UHC program, BeaconLBS will need the following information:The test name, unique test identifier, all associated CPT codes and units billed for the following services:
- Tier 1 Molecular Pathology Procedures
- Tier 2 Molecular Pathology Procedures
- Genomic Sequencing Procedures
- Multianalyte Assays with Algorithmic Analyses that include Molecular Pathology Testing
- CPT® codes: 0001U; 0004M – 0008M; 81161 – 81421; 81423 – 81479; 81507; 81519; 81545 – 81599
Laboratories will not be able to complete the prior authorization on behalf of physicians. As a result, labs will want to inform ordering physicians, with whom they regularly deal with, of UHC’s Genetic and Molecular Testing Prior Authorization/Notification Program and its Nov. 1, 2017 effective date.
For additional information, reference UnitedHealthcare’s August 2017 Network Bulletin (page 12). Training resources will be available on UHCprovider.com > Prior Authorization and Notification beginning in early October 2017.
As more payers start to require prior authorization for genetic and molecular testing, labs may want to consider adopting Strategies for Managing Genetic and Molecular Test Preauthorization. To secure reimbursement, control costs, and maximize profits, labs will need to determine how best to integrate prior authorization verification into their accession and revenue cycle workflows.
(*) While UHC’s program will be national, laboratory services ordered by Florida network providers for fully insured UHC Commercial Plan members in Florida will not have to participate in this requirement due to their participation in the UHC Laboratory Benefit Management Program.