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
- 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.