Prevea360 Health Plan updated medical policies for Genetic Testing in June 2017, and continues to update policies 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.
Here are a few things to consider:
For services that require authorization, submit prior authorization requests via the Prevea360 Health Plan provider portal
View a list of genetic tests that require prior authorization.
Providers without portal access may fax the genetic testing prior authorization form to the number indicated on the form.
Certain tests require pre-test and post- test genetic counseling. Prior authorization is not required for referrals to a genetic counselor.
St. Vincent Genetic Counseling department can provide genetic counseling for Prevea360 Health Plan members.
Members can be referred to St. Vincent Genetic Counseling at 920-433-8559 (fax 920-431-3138). Additionally, if there are in-network providers who employ genetic counselors may continue to use a current process that may be in place to comply with Prevea360 Health Plan’s updated genetics testing medical policies where genetic counseling is required.
Prevea360 Health Plan recognizes the limited accessibility of genetic counselors. We've partnered with InformedDNA (IDNA) to provide telephonic genetic counseling services for Prevea360 Health Plan members. The goal is to improve member satisfaction and ease the burden for our providers.
If no genetic counselors are available within your organization or there is an access issue, Prevea360 Health Plan’s member may be referred to InformedDNA (IDNA). Use the IDNA Cancer Genetic Counseling Referral form or the Cardiac Genetic Counseling Referral form to refer to IDNA.