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New utilization management program for genetic/genomic testing and certain molecular analyses

March 31, 2016

Effective July 1, 2016, for all commercial HMO and PPO members, Independence will be working with CareCore National, LLC d/b/a eviCore healthcare (eviCore), an independent company, 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.


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