Effective July 1, 2016, for all commercial HMO and PPO
members, AmeriHealth will be working with CareCore National, LLC d/b/a eviCore
healthcare (eviCore) for utilization management of genetic/genomic testing and
certain molecular analyses.
This new utilization management program through eviCore will encompass
precertification and/or prepayment review as follows:
- Precertification will be required for certain genetic/genomic tests.
- All genetic/genomic tests, along with certain molecular analyses (e.g.,
immunohistochemistry [IHC], morphometric analyses) and molecular cytogenetic
tests (e.g., fluorescent in situ hybridization [FISH], comparative genomic
hybridization [CGH]), will be reviewed prior to claim payment.
Look for more information regarding the new utilization management program
for genetic/genomic testing and certain molecular analyses in future editions
of Partners in Health UpdateSM.