Molecular Diagnostic and Genetic Testing (MD/GT)
Preauthorization of MD/GT is required for commercial (including members with Humana individual products), Medicaid and Medicare Advantage (MA) health maintenance organization (HMO) and preferred provider organization (PPO) members. In Puerto Rico, preauthorization is required for all commercial products. The terms prior authorization, precertification, preadmission and preauthorization all refer to the preauthorization process.
Humana does not review preauthorization requests for the following, as health care providers who participate in an independent practice association (IPA) or other risk network with delegated services need to refer to their IPA or risk network for guidance on processing preauthorization requests:
- MA members in HMO groups in Florida, Illinois, Nevada, Arizona and California
- For MA Private Fee-for-Service (PFFS) members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.
- Preauthorization is not required for services provided by nonparticipating health care providers for MA PPO members. Notification is requested, but not required, as this helps coordinate care for our members.