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Genetic and molecular testing prior authorization/advance notification

We’re dedicated to coordinating coverage guidelines and policies for genetic testing to enhance population health outcomes, ensure positive care experiences and offer affordable products. By collaborating with you, we can provide access to promising new treatments in this emerging field, helping create a balance between patient safety and clinical evidence.

Ordering care providers can complete the prior authorization/advance notification process online or by phone. Laboratories must register their tests in the UnitedHealthcare Genetic Test Registry to participate as part of the genetic and molecular testing prior authorization/advance notification process.

To submit and manage your prior authorizations, please sign in to the UnitedHealthcare Provider Portal.

Live training

We offer live training sessions for the genetic and molecular testing prior authorization/advance notification program.

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Tests requiring prior authorization/advance notification

For the current list of product-specific genetic and molecular testing prior authorization/advance notification requirements, visit our Advance Notification and Plan Requirement Resources page.

Plans the requirement applies to

UnitedHealthcare commercial plans: Prior authorization/advance notification for genetic and molecular testing performed in outpatient settings is a requirement for the following UnitedHealthcare commercial benefit plans where UnitedHealthcare is the primary payer. Effective dates are as follows:

  • Nov. 1, 2017, for UnitedHealthcare of the Mid-Atlantic, Inc.
  • April 1, 2018, for UnitedHealthcare Plan of the River Valley, Inc. and UnitedHealthcare Insurance Company of the River Valley
  • July 1, 2019, for Oxford Health Insurance, Inc. 
  • April 1, 2020, for UnitedHealthcare Level Funded (formerly All Savers Insurance Company and All Savers Life Insurance Company of California)
  • Jan. 1, 2021, for Neighborhood Health Partnership, Inc.

UnitedHealthcare Individual Exchange plans: We require prior authorization/advance notification for genetic and molecular testing performed in outpatient settings.

UnitedHealthcare Community Plan: We require prior authorization/advance notification for genetic and molecular testing performed in outpatient settings for UnitedHealthcare Community Plans in certain states, effective:

  • Feb. 1, 2019: Maryland, Michigan, Missouri, New York, Tennessee and Texas
  • March 1, 2019: Florida
  • April 1, 2019: New Jersey and Rhode Island
  • Feb. 1, 2020: Pennsylvania
  • May 1, 2020: Virginia
  • July 1, 2020: Hawaii and Wisconsin
  • Sept. 1, 2020: Washington
  • Nov. 1, 2020: Ohio
  • Dec. 1, 2020: Kansas
  • Jan. 1, 2021: Kentucky
  • July 1, 2021: North Carolina
  • Oct. 1, 2021: Mississippi
  • Jan. 1, 2022: Minnesota
  • Oct. 1, 2023: Nebraska
  • July 1, 2024: New Mexico

Plans the requirement doesn't apply to

UnitedHealthcare® Medicare Advantage: We don’t require prior authorization/advance notification for genetic and molecular testing for these plans (this includes Dual Special Needs Plans).

Other benefit plans may have plan-specific prior authorization/advance notification requirements for genetic and molecular tests.

Frequently asked questions

Questions?

If you have questions about the prior authorization/advance notification process or want to complete prior authorization/advance notification by phone, call 877-303-7736, 7 a.m.–7 p.m. CT, Monday–Friday.