​eviCore Lab Management Program expanding to Medicare Advantage members

October 1, 2020

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.

Precertification process

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 initiate precertification for genetic/genomic tests in one of the following ways:

  • NaviNet® web portal (NaviNet Open). Select eviCore from the Authorizations option in the Independence Workflows menu.
  • Telephone. Call eviCore directly at 1-866-686-2649.

Important information for laboratories

When a request for certain genetic/genomic testing is received, laboratories must ensure a precertification is on file before rendering services. If a precertification is not on file for the member, it is the laboratory’s responsibility to go through the above precertification process through eviCore.

Prepayment review

All genetic/genomic tests, along with certain molecular analyses and cytogenetic tests, are reviewed by eviCore prior to final claim adjudication and payment (if applicable). Examples of molecular analyses and cytogenetic tests include, but are not limited to:*

  • flow cytometry
  • fluorescent in situ hybridization (FISH)
  • immunohistochemistry (IHC)
  • karyotyping
  • morphometric analyses

Lab management policy

Independence is currently creating a Medicare Advantage policy for the eviCore Lab Management Program.

Learn more

We will communicate more information about this program expansion in the coming months through Partners in Health UpdateSM articles and through the Medical Policy Portal.

*This list of services is subject to change.

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