As previously communicated in a Partners in Health UpdateSM article, effective January 1, 2021, Independence is expanding its utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests for all Independence Medicare Advantage members. We are working with eviCore healthcare (eviCore), an independent specialty benefit management company, to manage precertification and/or prepayment coverage reviews for these tests.
Independence implemented this program for commercial members in 2016.
To view the full list of tests that require precertification, you can access the Independence Blue Cross Prior Authorization Procedure List on eviCore's website.
Please note that the ordering provider or laboratory is responsible for submitting precertification requests for the applicable tests. If the precertification request is not approved, the provider or laboratory will be liable for the cost of the test.
Lab management policy
To further explain the program, Independence created Medicare Advantage policy #MA06.034: eviCore Lab Management Program, which will be posted as a Notification on December 1, 2020, and will go into effect on January 1, 2021.
To view the Notification for this policy, on or after December 1, 2020, visit our Medical and Claim Payment Policy Portal.
For more information on the eviCore Lab Management Program, please call Provider Services at 1-800-ASK-BLUE (1-800-275-2583).