Last year, Independence introduced a new utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests for all commercial Independence members. We are working with CareCore National, LLC d/b/a eviCore healthcare (eviCore), an independent specialty benefit management company, to manage precertification and/or prepayment coverage reviews for these tests.

Please note that the ordering provider is responsible for submitting precertification requests for the applicable tests. Failure to adhere to the precertification process may result in your Independence patients receiving a bill for the testing.

Precertification requirements

Ordering health care providers must contact eviCore to obtain precertification for certain genetic/genomic tests, including, but not limited to, the following:*

• BRCA gene testing
• genetic panels and cancer gene expression tests
• genome-wide tests
• pharmacogenomic tests

You can access the Independence Blue Cross Prior Authorization List on eviCore?s website.

You can initiate precertification for genetic/genomic tests in one of the following ways:

• NaviNet^? web portal. Select CareCore from the Authorizations option in the Independence Workflows menu.
• Telephone. Call eviCore directly at 1-866-686-2649.

Prepayment review

All genetic/genomic tests, along with certain molecular analyses and cytogenetic tests, are reviewed by eviCore prior to final claim adjudication and payment (if applicable). Examples of molecular analyses and cytogenetic tests include, but are not limited to, the following:*

• flow cytometry
• fluorescent in situ hybridization (FISH)
• immunohistochemistry (IHC)
• karyotyping
• morphometric analyses

Lab management policy and guidelines

Review Medical Policy #06.02.52f: eviCore Lab Management Program for more information about the utilization management program. The policy includes a link to the Lab Management Guidelines that eviCore uses during the precertification and prepayment review processes, as well as a listing of procedure codes requiring precertification and/or prepayment review.

To view this policy, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, then select the Commercial tab from the top of the page and type the policy name or number in the Search field.

More information

If you have questions about any of these requirements, call Customer Service at 1-800-ASK-BLUE.

*This list of services is subject to change.

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