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Genetic testing

Closeup of a female provider looking through a microscope in a lab

Genetic testing policy update

Dean Health Plan updated medical policies for Genetic Testing in June 2017.

Here are a few things to consider:

  • Current Medical Policy MP9012 serves as the general policy for genetic testing and will provide links to specific genetic tests.
  • If a medical policy does not refer to a specific genetic test, applicable evidenced based guidelines and a prior authorization will be required.
  • Authorization, genetic counseling and medical necessity requirements may be test specific, as identified within each medical policy.
  • Medical necessity criteria will be applied to Commercial HMO, POS, PPO, BadgerCare and ASO members. Dean Advantage and DeanCare Gold do not have genetic testing authorization requirements.
  • ASO members are excluded from the Genetic Counseling requirement.
Certain tests require pre-test and post- test genetic counseling. Prior authorization is not required for referrals to a genetic counselor. **As a reminder, ASO members are excluded from this requirement
 
Dean Health Plan in-network providers who employ genetic counselors may continue to use a current process that may be in place to comply with Dean Health Plan’s updated genetics testing medical policies where genetic counseling is required.
Dean Health Plan recognizes the limited accessibility of genetic counselors. We have partnered with InformedDNA (IDNA) to provide telephonic genetic counseling services for Dean Health Plan members. Our 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, Dean 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.
 
For services that require authorization, submit prior authorization requests via the Dean Health Plan provider portal. 

Providers without portal access may fax the genetic testing prior authorization form to the number indicated on the form. 

For laboratories only—Every genetic test is assigned a genetic testing unit (GTU), a unique alphanumeric identifier for payers who utilize Concert Genetic services. This unique GTU may be found on the Concert Genetic Platform. Every genetic test has been assigned a GTU. Log in at concertgenetics.com to find the GTU for the genetic test you are requesting.
If you have any questions contact our Customer Care Center at (800) 279-1301 with any additional questions.