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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

March 2018

Genetic Testing Authorization Updates

With Harvard Pilgrim’s prior authorization program for genetic testing taking effect for commercial members on March 1, 2018, please share the following tips with your practice and office staff to minimize any disruption:

  • Authorization requests — The ordering clinician is responsible for obtaining prior authorization through AIM Specialty Health® (AIM). Ordering providers should request prior authorization in one of the following ways:
    • Online at www.providerportal.com (registration instructions are available online)
    • By telephone at 855-574-6476 (Mon.–Fri., 8 a.m.– 5 p.m. EST)
  • Convenient access through HPHConnect — For greater ease, HPHConnect offers single-sign on, providing users with access to a link to the AIM Specialty Health portal where you can enter genetic testing authorization requests. In addition, you can view the status of your request in HPHConnect in real time. You’ll find this information in the Office Management section of HPHConnect.
  • Authorization status — Order numbers for authorized tests are available through AIM’s provider portal as soon as a test request is authorized, whether the request was submitted online or by phone. In addition, AIM will mail determination letters, including order numbers for authorized tests, to the ordering provider, servicing provider, and patient.
  • An important note for servicing providers — To ensure appropriate reimbursement, it is important that prior to processing any specimens for these specific genetic tests, your laboratory confirm that prior authorization was given and to obtain the AIM transaction number. Harvard Pilgrim will not provide reimbursement for genetic tests performed without prior authorization.
  • Genetic counselor registration in OptiNet® — For certain tests, genetic counseling may be required before the request can be authorized for commercial members; in this case, the ordering provider must provide the name of the genetic counselor and date of service. Having genetic counselors register in the system will help avoid unnecessary delays or denials. Please refer to these registration instructions for more information.

  • Resources for additional information

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