Laboratory Management Program manual available

Highmark has partnered with eviCore healthcare (“eviCore”) to ensure their members are receiving the most clinically appropriate genetic laboratory testing. eviCore has a team of genetic counselors and medical geneticists with national experience in genetic testing utilization management using evidence-based policies developed with trained genetic experts. Under Highmark’s Laboratory Management Program, eviCore will perform medical necessity reviews for select molecular and genomic tests performed in an outpatient setting. In addition, all claims associated with molecular and genetic procedure codes will be reviewed for accuracy and medical necessity, based on eviCore’s policies. Highmark’s new Laboratory Management Program for genetic testing was implemented on August 1, 2016. An overview of the program is now available in manual’s Chapter 6, Unit 4: Outpatient Radiology and Other Diagnostic Services.