December 1, 2022
Starting January 1, 2023, prior authorization will be waived for certain biomarker testing for Washington members living with cancer. The cancer must be stage III or IV, or it has come back after treatment, not responded to treatment, or spread throughout the body. Biomarker testing looks for changes to genes or proteins related to cancer.
AIM Specialty Health® reviews biomarker (genetic) testing. Retrospective review may still be performed for these tests. Prior authorization is still required for these tests when ordered for other reasons. In these situations, continue to submit requests through the AIM portal.
You can confirm if prior authorization is waived by using the code check tool. If a request for prior authorization for one of these tests is submitted through the AIM portal, there will be a prompt asking if the request relates to one of the cancer stages listed above. If so, the review will be stopped, and no other action will be needed to move forward with performing the test. If not, the prior authorization process will continue as usual.
Once the test has been performed, a review for medical necessity may be submitted using the AIM portal. This will be needed to process the claim.