Independence recently introduced a new utilization
management program for genetic/genomic tests,
certain molecular analyses, and cytogenetic tests for all
commercial Independence members. We are working
with CareCore National, LLC d/b/a eviCore healthcare
(eviCore), an independent specialty benefit management
company, to manage precertification and/or prepayment
reviews.
Please note that the ordering provider is responsible for
the prior authorization to ensure the member?s care is
not interrupted.
Precertification requirements
Ordering health care providers must contact eviCore to
obtain precertification for certain genetic/genomic tests,
including, but not limited to, the following:*
- BRCA gene testing
- genetic panels and cancer gene expression tests
- genome-wide tests
- pharmacogenomic tests
You can find the complete list of procedure codes
requiring precertification
here.
Submitting requests to eviCore
You can request precertification for genetic/genomic
tests by calling eviCore directly at 1-866-686-2649 or
submitting requests via the NaviNet® web portal. To
submit a request on NaviNet, select CareCore from the
Authorizations option in the Workflows menu, and a
new window will open that sends providers directly to
eviCore?s provider portal to initiate the precertification
process. Once on eviCore?s portal, you will be required
to create a login and password, which will be used every
time you request precertification through eviCore. If you
have already established credentials for eviCore?s portal,
please use your current login information.
Important information for laboratories
When a request for genetic/genomic testing is
received, laboratories must ensure a precertification
is on file before rendering services. If precertification
is not on file for the member, it is the laboratory?s
responsibility to submit a request to eviCore.
Prepayment review
All genetic/genomic tests, along with certain molecular
analyses and cytogenetic tests are reviewed by eviCore.
Examples of molecular analyses and cytogenetic tests
include, but are not limited to, the following:*
- comparative genomic hybridization (CGH)
- flow cytometry
- fluorescent in situ hybridization (FISH)
- immunohistochemistry (IHC)
- morphometric analyses
Lab management policy and guidelines
Review Medical Policy #06.02.52: eviCore Lab
Management Program for more information about the
utilization management program. The policy includes
a link to the Lab Management Program Clinical
Guidelines that eviCore uses during the precertification
and prepayment review processes, as well as a listing
of procedure codes requiring precertification and/or
prepayment review.
To view this policy, visit our Medical Policy Portal. Select
Accept and Go
to Medical Policy Online, then select the Commercial
tab from the top of the page and type the policy name or
number in the Search field.
More information
If you have questions about any of these requirements,
you can contact your Network Coordinator or call
Customer Service at 1-800-ASK-BLUE.
*This list of services is subject to change.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.