As a supplement to the information in the September 20 issue of Provider News, criteria for genetic counseling need to be met for specific services.
Effective January 4, 2019, pretest genetic counseling is needed for the tests described in the following AIM guidelines:
AIM will conduct prior authorization reviews for all genetic testing services performed on or after January 4, 2019. Reviews will be based on AIM’s Clinical Appropriateness Guidelines for Genetic Testing. Visit AIM Specialty Health CG-Generic Testing to review the guidelines.
Prior authorization for genetic tests can be requested online beginning December 17, 2018. All reviews have to go through AIM for dates of service beginning January 4, 2019.
Prior authorization can be made by submitting information 24/7 at providerportal.com or calling 866-666-0776, Monday through Friday, 8:00 a.m. to 6:00 p.m. Pacific Time. Note: Providers must register with AIM through providerportal.com to request prior authorization for services on behalf of members beginning January 4, 2019.
Only ordering providers or their staff members can submit requests. Servicing providers may access providerportal.com to verify the status of reviews.
AIM will review the request and submitted clinical information. Requests that meet criteria receive a response instantly along with an order number through AIM’s ProviderPortalSM or on the phone with the AIM contact center.
Determination letters, including order numbers for authorized tests, are mailed to the ordering provider and the patient. Order numbers for authorized tests are available through providerportal.com as soon as a test request is authorized whether the request was submitted online or by phone.
If a request can’t be approved, AIM’s program staff, including genetic analysts and physicians, are available to help resolve the request.
Claims submitted without prior authorization through AIM's ProviderPortal will be denied.
For more information about the clinical review process, visit aimprovider.com/genetictesting.
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