Genetic testing

Prevea360 Health Plan maintains and updates these genetic testing medical policies.

  • Current Medical Policy MP9012 will serve as the general policy for genetic testing and will provide links to specific genetic tests.
  • If a medical policy does not refer to a specific genetic test, applicable evidenced based guidelines and a prior authorization will be required.
  • Authorization, Genetic Counseling and Medical Necessity requirements may be test specific, as identified within each medical policy.
  • Medical necessity criteria will be applied to HMO, POS, PPO, and ASO members.

Genetic testing - prior authorization

For services that require authorization, submit prior authorization requests via the Prevea360 Health Plan provider portal

Providers without portal access may fax the genetic testing prior authorization form to the number indicated on the form. 

For laboratories only—Every genetic test is assigned a genetic testing unit (GTU), a unique alphanumeric identifier for payers who utilize Concert Genetic services. This unique GTU may be found on the Concert Genetic Platform. Every genetic test has been assigned a GTU. Log in at concertgenetics.com to find the GTU for the genetic test you are requesting.

Genetic counseling requirement

Certain tests require pre-test and post- test genetic counseling. Prior authorization is not required for referrals to a genetic counselor.

Genetic Counseling Resources

St. Vincent Genetic Counseling department can provide genetic counseling for Prevea360 Health Plan members.

Members can be referred to St. Vincent Genetic Counseling at 920-433-8559 (fax 920-431-3138). Additionally, if there are in-network providers who employ genetic counselors may continue to use a current process that may be in place to comply with Prevea360 Health Plan’s updated genetics testing medical policies where genetic counseling is required.

Prevea360 Health Plan recognizes the limited accessibility of genetic counselors. We've partnered with InformedDNA (IDNA) to provide telephonic genetic counseling services for Prevea360 Health Plan members. The goal is to improve member satisfaction and ease the burden for our providers. 

If no genetic counselors are available within your organization or there is an access issue, Prevea360 Health Plan’s member may be referred to InformedDNA (IDNA). Use the IDNA Cancer Genetic Counseling Referral form or the Cardiac Genetic Counseling Referral form to refer to IDNA.

Additional resources