AIM Genetic Testing Prior Authorization Change Effective July 1, 2019

4/22/2019

PacificSource is pleased to announce a new genetic testing program beginning July 1, 2019.

We have entered a new era of precision medicine, where treatments can be targeted and disease risks identified for individuals based on their unique genetic makeup. Today, there are more than 80,000 genetic tests available, and the number is growing. Navigating this rapidly advancing area of medicine can be a challenge for your practice and your patients.

PacificSource has partnered with AIM Specialty Health® (AIM) to help ensure quality care while reducing costs associated with testing that is not evidence-based. In collaboration with you, our valued providers, our genetic testing program will ensure our members have access to appropriate testing.

Key Information About the Program

  • The program promotes evidence-based, high-value care for our members requiring genetic testing. This includes:

    • Genetic testing for hereditary cardiac disease

    • Genetic testing for hereditary cancer susceptibility

    • Genetic testing for single-gene and multifactorial conditions

    • Pharmacogenetic testing and genetic testing for thrombotic disorders

    • Reproductive carrier screening and prenatal diagnosis

    • Molecular testing of solid and hematologic tumors and malignancies

    • Whole exome and whole genome sequencing

  • Medical necessity review is required for all members.

  • Medical necessity review can be requested, and the status of review requests checked, online at ProviderPortal.com (available 24/7) or by phone at (877) 291-0510, Monday–Friday, 5:00 a.m. to 4:00 p.m. Pacific Time.

  • Requests for medical necessity review can be made for genetic testing starting July 1, 2019.

  • Requests must be made by ordering providers. Servicing providers may access ProviderPortal.com for the purpose of verifying the status of reviews.

  • Requests for testing at in-network laboratories that meet medical necessity criteria are approved in real time.

To Learn More

For medical necessity criteria, including genetic counseling requirements for select tests, please visit: http://aimspecialtyhealth.com/CG-GeneticTesting.html

For more information about the medical necessity review process, please visit http://www.aimproviders.com/genetictesting/. Here you will find:

  • Tutorials on how to use the AIM ProviderPortalSM

  • FAQs

  • PacificSource Genetic testing FAQ

  • Worksheets to help you gather information needed to submit your review requests

We value your participation and look forward to working with you to help improve the health of our members.

Aim Specialty Health along with PacificSource Health Plans will be offering informational webinars.  Registration and invitations will be sent in the coming weeks, or please check our website for webinar dates and registration information at https://medicare.pacificsource.com/Providers/Events

If you have any questions, please contact our Provider Service team at providerservicerep@pacificsource.com .

 


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