Independence has 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.

Precertification requirements

For dates of service on or after July 1, 2016, ordering health care providers and/or laboratories 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 request precertification for genetic/genomic tests for dates of service on or after July 1, 2016, 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.

Prepayment review

For dates of service on or after July 1, 2016, all genetic/genomic tests, along with certain molecular analyses and cytogenetic tests, will be 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 will use 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.

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