LAB MANAGEMENT PROGRAM PRIOR AUTHORIZATION DATE CHANGE

Highmark has partnered with eviCore to ensure their members are receiving the most clinically appropriate laboratory testing. There is an important update to the Lab Management Program regarding Prior Authorization. The requirement for prior authorization for certain molecular and genomic tests when performed in an outpatient setting for fully insured Commercial, Affordable Care Act and Medicare Advantage members will now be effective with dates of service on or after Aug., 2016. The requirement that all claims associated with molecular and genomic procedure codes be reviewed for accuracy and medical necessity, based on eviCore’s policies, will still begin on Aug. 1, 2016.

Source: https://www.highmarkblueshield.com/health/pdfs/pubs/tm-hbs-evicore-lab-management-program-062416.pdf