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.
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.