Compliance Alert: Authorization required for genetic testing.

Reduce claim denials and ensure timely reimbursement.

Please review the following reminder regarding genetic testing services.

Ordering providers — action required.

Before ordering genetic testing:

1. Access the Martin’s Point Health Care Provider Portal.
2. Use the Benefits & Eligibility tool to verify:
   • Member eligibility
   • Benefit coverage
   • Authorization requirements (enter specific CPT/HCPCS codes)
3. If required, submit the request through ProAuth prior to rendering services.

ProAuth provides:

• Real-time submission
• Immediate status tracking
• Automated determinations for certain requests
• Confirmation documentation for your records

Authorization must be approved before services are performed.

Laboratory providers — verification required.

Laboratories must verify an approved authorization is on file in ProAuth before processing genetic testing. 

• Do not rely solely on the ordering provider’s confirmation
• Confirm approval in the Provider Portal prior to rendering services

Important.

Claims submitted without an approved authorization will be denied. 

We appreciate your immediate attention to incorporating these steps into your workflow to prevent unnecessary denials and administrative rework.