Baylor Genetics is pleased to be your genetic testing partner, and we strive to keep you informed of updates that affect your patients and team.
Effective November 1st, 2017, UnitedHealthcare requires ordering care providers to request online notification/prior authorization for genetic and molecular laboratory testing for UnitedHealthcare Commercial benefit plan members before laboratory tests can be reimbursed. The following tests and CPT codes have been impacted:
Genetic and Molecular Laboratory Tests include:
- Tier 1 Molecular Pathology Procedures
- Tier 2 Molecular Pathology Procedures
- Genomic Sequencing Procedures
- Multianalyte Assays with Algorithmic Analyses that include Molecular Pathology Testing
CPT Codes include:
- 0004M – 0008M
- 81161 – 81421
- 81423 – 81479
- 81545 – 81599
- 0009M (prior authorization required starting Jan. 1, 2018)
Here is a copy of the Physician’s User Guide, which can guide you through the process of creating a notification/prior authorization.
To access Link, please follow the steps below:
(1) Using your Internet Browser, go to www.UHCprovider.com and click on Link in the upper right-hand corner.
(2) To access the Genetic and Molecular Test app, you must sign in to Link.
(3) If you do not have an Optum ID or password, or need help remembering your credentials, click New User.
Baylor Genetics is a participating lab provider on the Link portal allowing you access to our laboratory’s tests. For assistance in navigating the portal, contact our billing department at 1-800-411-4363.
Ordering care providers can also call BeaconLBS at 800-377-8809 to start the notification/prior authorization process.
If the request meets UnitedHealthcare’s clinical and coverage guidelines, a decision will be provided upon submission of the online request. UnitedHealthcare will contact you if additional information or clinical documentation is needed. In order to avoid denials, we will follow up with your office on the status of pre-authorization to assist in the process. To view specific UnitedHealthcare Medical Policy please see below:
- Carrier Testing for Genetic Diseases
- Fetal Aneuploidy Testing Using Cell-Free Fetal Nucleic Acids in Maternal Blood
- Genetic Testing for Hereditary Cancer
- Chromosome Microarray Testing
- Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions
- Whole Exome Sequencing and Whole Genome Sequencing
Baylor Genetics is here to assist you in learning the new prior authorization requirements, procedures, and Link instructions. Please contact your sales representative if you would like an in-office visit to assist your team in learning the process for prior authorization.
We’re here to provide you guidance as we adopt this new process and continue to serve your patients together.