Genetic Testing Services to use McKesson’s InterQual Molecular Diagnostics Criteria

Effective April 1, 2017, all HUSKY Health medical policies currently in use by Community Health Network of Connecticut, Inc. (CHNCT) to review requests for genetic testing services will be retired. McKesson’s InterQual Molecular Diagnostics Criteria will instead be used, in conjunction with the Department of Social Services’ (DSS) definition of medical necessity (see section 17b-259b of the Connecticut General Statutes). The Criteria provides evidence-based clinical decision support for molecular and genetic tests. The Criteria will be used as guidelines only. Should the criteria ever conflict with the DSS definition of medical necessity, the definition of medical necessity shall prevail. A listing of the molecular pathology and molecular diagnostic procedures requiring prior authorization may be found on the laboratory fee schedule located on the DSS (CMAP) website at: www.ctdssmap.com.There are no changes to the PA submission process. PA requests that pend for 20 business days without receipt of all requested documentation are subject to denial.

Source: https://www.ctdssmap.com/CTPortal/Information/Get Download File/tabid/44/Default.aspx?Filename=PB17_08_1.pdf&URI=Bulletins/PB17_08_1.pdf