New Clinical Guidelines – Prior Authorization (PA) of Genetic Cancer Susceptibility Panels Using Next Generation Sequencing

Effective August 1, 2017, new clinical guidelines will be used in conjunction with the Department of Social Services’ (DSS) definition of medical necessity to render determinations on prior authorization (PA) requests for Genetic Cancer Susceptibility Panels Using Next Generation Sequencing. The new policies will be made available on the HUSKY Health Web site at: Providers must submit clinical information supporting the medical necessity of the requested service or item. PA requests submitted without sufficient clinical information to support the decision-making process will be held in a pended status until all required information is received by DSS’ medical administrative services organization, Community Health Network of Connecticut, Inc. (CHNCT). PA requests that pend for twenty (20) business days without receipt of all required documentation are subject to denial. There are no changes to the PA submission process. Providers may continue to fax the completed Outpatient PA Request Form or submit the request via the medical prior authorization Web portal.

INDUSTRY NEWS TAGS: Medicaid Connecticut

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