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Genetic testing prior authorization best practices
September 18, 2019

This article is for:

  • Genetic counselors
  • Providers who order genetic tests
  • Laboratories that perform genetic tests

Since implementing a prior authorization program with AIM Specialty Health®′, we have noticed situations in which the authorized test or tests do not match the services billed by the laboratory performing the test.

We would like to share the following best practices with providers ordering genetic tests and those performing them. Following these best practices will help with claims processing and members avoiding costs for non-authorized services.

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Doctors and clinicians ordering genetic tests

Please remember to request prior authorization from AIM before you send the specimen to the lab. As part of your contract with us, you’re required to follow our medical management policies.

Here are additional best practices:

  • Once you’ve submitted your authorization request, you’ll receive a response. If your authorization is approved, AIM ProviderPortalSM will indicate it’s “Authorized” in the Order Request Preview (see (see  in the example below).
  • Tell the member that they must have the test within the timeframe approved (see  in example). Otherwise, if the test is outside of those dates, a new authorization request will be needed.

  • Attach a copy of the approved authorization to your lab requisition form. This will help the lab understand what's been approved. You’ll be able to download a PDF or print a copy (see  in example) after you have submitted your authorization request and it’s been approved.
    • Click "View Details" ( in example) to see all CPT codes associated with the test that are approved. Remember: You will need to make sure you have approval for each CPT code.

Important: We recommend attaching a copy of the approved authorization to your lab requisition instead of using a pre-populated lab requisition form, such as the one in the example below. When you enter the test into AIM’s ProviderPortal, you are requesting the individual test, not a panel, so the test authorized and the pre-populated form are not always a match.

Laboratories that perform genetic tests

When a specimen comes into your lab for genetic testing, before you analyze the specimen, please remember to verify:

  • An approved authorization for the test. You can verify the authorization approval by going to the AIM ProviderPortal.
  • The CPT codes approved as part of that authorization. Next, you can give those codes to your billing department for your claim, so your claims will process smoothly.
    • Click "View Details" (See  in the example) to see any CPT codes associated with the test that are approved.

Additional information about the program

Questions?

For questions about the genetic testing prior authorization program with AIM, call Network Management and Credentialing Services at 1-800-316-BLUE (2583).

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