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

May 2018

Sign Up for a Webinar on Our Genetic Testing Program

Harvard Pilgrim and AIM Specialty Health® (AIM) are offering additional webinar sessions for providers, including genetic counselors, and office staff who wish to learn more about our genetic testing prior authorization program.

Harvard Pilgrim requires prior authorization through AIM for genetic tests, including those associated with: hereditary cardiac disease; hereditary cancer susceptibility; single-gene and multifactorial conditions; pharmacogenetics and thrombotic disorders; reproductive carrier screening and prenatal diagnosis; solid and hematologic tumors and malignancies; and whole exome/genome sequencing. Additionally, preauthorization through AIM is required for the CPT codes 89290 and 89291 associated with preimplantation genetic diagnosis.

Webinars offered in May
Our one-hour webinars will provide useful information about the program and an opportunity to receive answers to any questions you may have. Sessions will be offered on the following dates:

Registration is not required. For information and to connect to the meeting, please visit the webinar websites provided above.

Important reminders

  • To request authorization — The ordering clinician is responsible for obtaining prior authorization through AIM. Ordering providers should request prior authorization in one of the following ways: online at www.providerportal.com (registration instructions are available online) or by telephone at 855-574-6476 (Mon.–Fri., 8 a.m.–5 p.m. EST). In addition, 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. You can also view the status of your request in HPHConnect in real time.
  • Genetic counselor registration required — 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.
  • Use participating labs — It’s important to use one of Harvard Pilgrim’s participating labs to process genetic tests. Referring to non-participating laboratories can result in denials, member liability, or a higher member cost share, depending on the member’s coverage. You can find the complete list of laboratory providers participating in Harvard Pilgrim’s network in our Provider Directory.
  • Information for labsPrior to processing any specimens for these specific genetic tests, laboratories should confirm that prior authorization was given and obtain the AIM transaction number. Harvard Pilgrim will not provide reimbursement for genetic tests performed without prior authorization.

Resources for additional information
For additional information, please refer to these resources:

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