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​​Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests

April 29, 2016

Independence has introduced a new utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests for all commercial Independence members. Independence will work with CareCore National, LLC d/b/a eviCore healthcare (eviCore), an independent specialty benefit management company, to manage precertification and/or prepayment reviews. This utilization management program 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 and cytogenetic tests, will be reviewed prior to claim payment.

Precertification requirements

Effective for dates of service on or after July 1, 2016, ordering health care providers and/or laboratories must contact eviCore to obtain precertification for certain genetic/genomic tests, that include, but are not limited to, the following:*

  • BRCA gene testing
  • genetic panels and cancer gene expression tests
  • genome-wide tests
  • pharmacogenomic tests
These changes will be reflected in an updated precertification requirement list, which will be posted to our website later this month.

Submitting requests to eviCore

Starting June 27, 2016, you can request precertification for genetic/genomic tests for dates of service on or after July 1, 2016, by calling eviCore directly at 1-866-686-2649 or submitting requests via the NaviNet® web portal.

To submit a request on NaviNet, select CareCore from the Authorizations option in the Workflows menu, and a new window will open that sends providers directly to eviCore's provider portal to initiate the precertification process. Once on eviCore's portal, you will be required to create a login and password, which will be used every time you request precertification through eviCore. If you have already established credentials for eviCore's portal, please use your current login information.

Prepayment review

Starting July 1, 2016, all genetic/genomic tests, along with certain molecular analyses and cytogenetic tests, will be reviewed by eviCore prior to claim payment. Examples of molecular analyses and cytogenetic tests include, but are not limited to, the following:*

  • comparative genomic hybridization (CGH)
  • fluorescent in situ hybridization (FISH)
  • immunohistochemistry (IHC)
  • morphometric analyses

Lab management policy and guidelines

A medical policy has been created to provide information about this utilization management program: #06.02.52: eviCore Lab Management Program, which will be posted as a Notification on May 2, 2016, and will become effective July 1, 2016. The policy will include a link to eviCore's Lab Management Program Clinical Guidelines, which will be used during the precertification and prepayment review processes, as well as a listing of procedure codes that will require precertification and/or prepayment review.

To view the Notification for this policy, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial under Notifications.

More information

If you have questions about any of these requirements, you can contact your Network Coordinator or call Customer Service at 1-800-ASK-BLUE.

*This list of services is subject to change.

Tutorial webinars by eviCore

To assist you in using their provider portal, eviCore will host the following tutorial webinars called "Independence Blue Cross Laboratory Management Program Provider Orientation Session":

  • June 27, 2016, 2 ? 3 p.m.
  • June 28, 2016, 10 ? 11 a.m.
If you are interested in participating, visit eviCore?s WebEx page, select the Training Center tab, and then choose your preferred session from the Upcoming tab. If you have any questions about signing up for these training sessions, please send an email us.

NaviNet is a registered trademark of NaviNet, Inc., an independent company. 


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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