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On January 1, Federal Employee Program (FEP) plans introduced a simplified authorization process for genetic testing to provide easier access. However, even with this simplification, we’ve noticed several common trends leading to denied claims, misdirected authorization requests, and an increase in appeals.
We’d like to help you
Because the rules for FEP can vary from what you do for our other plans, we’ve listed tips below. We aim to help reduce administrative time spent on claim appeals and member confusion about their coverage and health care costs.
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Blue Cross Blue Shield of Massachusetts is receiving claims for services rendered in a different state. For genetic tests that require prior approval, we are also receiving prior approval requests for services rendered outside of Massachusetts. |
- Laboratories should submit claims and prior approval requests to the plan in the state where the test is performed.
- For members outside of Massachusetts who receive genetic tests from a laboratory in Massachusetts: Submit the prior approval request (when required) and the claim to Blue Cross Blue Shield of Massachusetts.
- For members living in Massachusetts whose genetic tests are performed by a laboratory outside of Massachusetts: Request prior approval from the Blue plan in the state where the test is performed. Submit claims to that plan.
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We’re receiving multiple authorization requests for genetic tests within a short period of time because the order for the test has changed.
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- If the genetic test selected needs to change after the member has consulted with their doctor or a genetic counselor, have the approved test cancelled.
- To cancel your existing authorization, call 1-800-689-7219 or fax us at 1-888-282-1315.
- Then, once your previous authorization has been cancelled, you can order the new one and request authorization by using Authorization Manager.
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Laboratories are billing CPT codes not approved in the authorization, such as not otherwise classified (NOC) codes, leading to claim rejections. |
- Have your billers use the approved codes from laboratory requisitions to bill us only for codes that were approved.
- Review authorizations/prior approval information using Authorization Manager.
Thank you for sharing this information with your billing departments.
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