Dna preauth

Molecular diagnostic and genetic testing (MD/GT)

Preauthorization of MD/GT is required for patients with commercial (including Humana individual products), Medicaid and Medicare Advantage (MA) health maintenance organization (HMO) and preferred provider organization (PPO) products. 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 healthcare professionals 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 Arizona, California, Florida, Illinois or Nevada

Please note:

  • 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 your patients.
  • Preauthorization is not required for services provided by nonparticipating healthcare providers for MA PPO patients. Notification is requested, but not required, as this helps coordinate care for your patients.

Humana's Genetic Guidance Program

The genetic guidance program is a utilization management initiative designed to share information with physicians and their Humana-covered patients about the use and appropriateness of MD/GT. Board-certified genetic counselors are available to discuss genetic testing services, and preauthorizations. To initiate a request, you may call 1-800-523-0023. Representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday.

Submitting preauthorization requests

All physicians and Puerto Rico local labs have several options when submitting their preauthorization requests:

  • Online: Healthcare professionals may initiate preauthorization requests through Availity, and the requests will be directed to our genetic counselors. Registration is required to use Availity.com.
  • By phone: Physicians may initiate a preauthorization request by calling Humana's Interactive Voice Response system (IVR) at 1-800-523-0023. If needed, representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday. A board-certified genetic counselor may 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. The requestor will receive notification of the outcome of the request.
  • By fax: Physicians/local labs also may request preauthorization via fax. To do so, download the preauthorization request form below, fill it out in its entirety and fax it to us at 1-855-227-0677. 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 via phone or fax; non-approvals are sent via mail.

Request Form (English)

(265 KB) Download PDF English (opens in new window)

Request Form (Spanish)

(86 KB) Download PDF Spanish (opens in new window)

Texas preauthorization request form (opens in new window)

Physicians and other clinicians in Texas may use this form to submit MD/GT preauthorization requests for their Humana-covered patients. Instructions are available here (opens in new window). Once complete, please fax the form to Humana at 1-855-227-0677. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Indiana preauthorization request form (opens in new window)

Physicians and other clinicians in Indiana may use this form to submit MD/GT preauthorization requests for their Humana-covered patients. Instructions are included on the form. Once complete, please fax the form to Humana at 1-855-227-0677. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Information needed when requesting preauthorization

The physician should have relevant clinical information available when requesting preauthorization, including:

  • Patient’s Humana member ID number
  • Ordering physician name and NPI 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 code)
  • Test being ordered (CPT® code or test name)
  • Indication/reason for test
  • Signs, symptoms and duration
  • Prior related diagnostic and/or genetic tests and their results
  • Laboratory studies and results
  • Family medical/genetic history
  • 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 preauthorization, the following categories are excluded:

  • Routine prenatal screening —
    (Please note: Non-invasive prenatal testing does require preauthorization.)
  • 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 healthcare professional should contact Humana to request preauthorization.

Additional resources

Clinical policies

To learn more about Humana's clinical policies for molecular diagnostic/genetic tests, search for the term "genetic" using the Medical Coverage Policies Tool.

Program flyer

An educational flyer summarizing the contents of this web page. It provides an overview of the Humana Genetic Guidance Program and the process for requesting preauthorization.