October 4, 2018
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:
- Genetic Testing for Hereditary Cardiac Disease
- Genetic Testing for Hereditary Cancer Susceptibility
- Whole Exome and Genome Sequencing
September 20, 2018
AIM Specialty Health® (AIM) will manage review of genetic testing services
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.
When is this change effective?
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.
How can I request a review?
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.
Who can request a review?
Only ordering providers or their staff members can submit requests. Servicing providers may access providerportal.com to verify the status of reviews.
How long does it take to get a response?
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.
Is a letter sent to the provider?
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.
What if my request isn’t approved?
If a request can’t be approved, AIM’s program staff, including genetic analysts and physicians, are available to help resolve the request.
What if I don’t submit a test for review?
Claims submitted without prior authorization through AIM's ProviderPortal will be denied.
Where can I go to get more information about AIM’s process?
For more information about the clinical review process, visit aimprovider.com/genetictesting.
Look for:
- Details about upcoming informational webinars – available under the Welcome tab
- Tutorials on how to use the AIM ProviderPortal – available under the Program Resources tab
- Frequently asked questions (FAQs) – available under the Program Resources tab
- Worksheets to help you gather information needed to submit your review requests – available under the How To Participate tab
Who can I contact with my questions?
For questions about this article, email Provider Relations at provider.relationswest@premera.com.