Reminder: Genetic Testing Requires Prior Authorization

Getting a prior authorization for genetic testing helps make sure your patient’s claim isn’t delayed or denied. Many genetic testing claims, including prenatal genetic screening, are denied due to missing prior authorizations. This often happens when tests are sent directly to the lab without confirming whether 1.) prior authorization is required or 2.) the lab is in network.

Please make sure prior authorization is obtained through Carelon before sending specimens to the lab. We recommend that clinic staff verify test requirements at the time of order entry and include prior authorization steps in standard workflows for all genetic tests.

For more information, refer to the Carelon Clinical Appropriateness Guidelines for Genetic Testing.