Prevea360 Health Plan updates medical policies for Genetic Testing biannually on an ongoing basis. As genetic testing has increasingly become the standard of care, Prevea360 Health Plan is committed to the access and quality of these services for our members.
Our current genetic testing policies were developed by our contracted vendor Concert Genetics, an industry leader in genetic testing technology assessment and policy development. To search for the genetic testing medical policies, visit the document library page and enter Genetic Testing in the “Search for” box.
Although prior authorization is no longer required for genetic testing as of 7/1/2023 when utilizing providers allowed under the member’s plan, claims will still need to be coded correctly and services still need to be medically necessary based on coverage criteria. Claims may be denied if this information is not provided or accurate.
Not all genetic tests are considered a covered benefit under the member’s plan. Please contact the Customer Care Center at 877-230-7555 to confirm the recommended testing is a covered benefit of the member’s plan.