Humana's Genetic Guidance Program
The Genetic Guidance Program is a utilization management initiative designed to share information with physicians and members about the use and appropriateness of MD/GT. Board-certified genetic counselors are available to discuss genetic testing services, and preauthorizations follow Humana's clinical policies. Providers and members interested in speaking with a counselor should call 1-8s77-506-5193. Representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday.
DNA Direct facilitates medically necessary MD/GT at participating laboratories.
Submitting Preauthorization Requests
Physicians and local labs (Puerto Rico only) have several options when submitting their preauthorization requests:
Submit requests online
Physicians/local labs may log into Humana's Genetic Guidance Center website at DNA Direct to preauthorization requests. They will be asked to provide information about the patient's condition and medical/family history. Physicians/local labs will receive a response to their request at the end of the process. They will also have access to online educational information about the indication and use of the MD/GT they are ordering.
To protect the privacy and confidentiality of our members’ personal health information, physicians requesting preauthorization through DNA Direct's website will be asked to register with DNA Direct. Physicians will create a username and password to submit a preauthorization request.
Submit requests by phone
Physicians/local labs may contact a DNA Direct representative by phone at 1-877-506-5193. Representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday. A board-certified genetic counselor will ask the physician questions about the patient's condition and past medical/family history. Genetic counselors can also answer questions related to the test(s) the physician is ordering and applicable Humana clinical policies. In most cases, physicians will receive a decision on the prior authorization request before the end of the phone call. If a case requires further evaluation, the physician will receive written notification of its outcome.
Submit requests by fax
Physicians/local labs may also request preauthorization from DNA Direct via fax. To do so, download DNA Direct’s preauthorization request form below, fill it out in its entirety and fax it to DNA Direct at 1-866-518-9738. A board-certified genetic counselor will review the request and contact the physician/local lab if additional information is required. Approvals of requests are returned by fax; denials are sent via mail.
Download DNA Direct’s preauthorization request form:
- United States Request Form
- (265 KB) Download PDF
- Puerto Rico Request Form
- (556 KB) Download PDF
Information Needed When Requesting Preauthorization
The physician should have relevant clinical information available in the patient's chart when requesting preauthorization, including:
- Member name and Humana member ID number
- Ordering physician name and provider ID or tax ID number
- Telephone and fax numbers of the ordering physician
- Name, telephone number and fax number of lab/facility performing the test
- Patient diagnosis or clinical indication (ICD-9 code)
- Test being ordered (CPT code or test name)
- Indication/reason for test
- Patient signs, symptoms and duration
- Prior related diagnostic and/or genetic tests and their results
- Laboratory studies and results
- Family medical/genetic history
- Patient medications and duration (if related)
- Prior treatments or other clinical findings (when relevant)
- How the test results will be utilized in the patient's care
- Local laboratory name, provider ID or tax ID (i.e., Puerto Rico lab or facility that will collect the sample— Puerto Rico only)
Exclusions to Preauthorization
While most genetic tests and molecular diagnostics require prior authorization, the following categories are excluded:
- Routine prenatal screening
- Routine inpatient newborn screenings
- Human leukocyte antigen (HLA) testing for transplant
- Chromosomal analysis for leukemia and lymphoma
- Infectious disease testing considered to be the standard of care
For all other tests, the health care provider should contact DNA Direct for preauthorization.
- Humana Genetic Guidance
- A list of genetic tests and disease states included in Humana’s Genetic Guidance Program
- (438 KB) Download PDF
To learn more about Humana's clinical policies for molecular diagnostic/genetic tests, search for the term "genetic" using the Medical Coverage Policies Tool.
An educational flier about the Genetic Guidance Program and the process for requesting preauthorization through DNA Direct
Questions about this program may be directed to DNA Direct at 1-877-506-5193. Representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday.