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April 25, 2018

Genetic Laboratory Testing

Idaho Medicaid coverage includes genetic testing or molecular pathology services performed in a credentialed lab, but only when such testing is considered under current standards to be reasonable and necessary for the diagnosis and potential treatment of an illness, disease, or condition.

 

The following types of genetic testing are not covered by Idaho Medicaid:

  • Tests performed for screening purposes only, in the absence of signs, symptoms, or personal history of disease or injury

  • Tests that are done solely to diagnose a patient, and will not impact medical decision-making for the patient or the patient’s treatment plan

  • Tests performed for the purposes of genetic counseling or family planning

  • Tests that do not meet the definition of medical necessity as set forth in IDAPA 16.03.09.011.16 

Assistance for Providers

The status of a prior authorization request may be checked online at Telligen’s Qualitrac portal, or by contacting Telligen at (866) 538-9510. If you have questions on a Denial, please refer to your Notice of Decision letter.  

You may submit requests for reviews by telephone, fax, standard mail, or online through Telligen’s Qualitrac portal.  Additional information on submitting a request for review is located in Telligen’s Provider Manual.  Contact information, fax cover sheets, and other information are available at Telligen’s website at http://IDmedicaid.telligen.com.

March 12, 2018 - Update

In order to streamline the process for reviewing genetic tests, all genetic codes except the following, will be reviewed by Telligen effective Monday, March 12th, 2018:

81225  Cyp2c19 gene analysis common variants;

81226  cyp2d6 gene analysis common variants;

81227  cyp2c9 gene analysis common variants;

81230  Gene analysis (cytochrome P450 family 3 subfamily A member 4) for common variant; 

81231  Gene analysis (cytochrome P450 family 3 subfamily A member 5) for common variant; and 

81355  vkorc1 gene analysis common variants.  

To ensure a smooth transition with this new process, the Division of Medicaid’s Medical Care Unit will redirect providers to the Qualitrac portal where they can submit genetic testing requests to Telligen.  This redirection and notice will be sent to the submitting provider until April 1st, 2018, at which point submission through Telligen should be considered the standard method of submitting requests.

You can view the updated list of codes requiring Telligen review here.

Telligen’s Idaho Medicaid page is a source of current information regarding the reviews Telligen conducts on behalf of Idaho Medicaid.”

Contact

Telligen

Phone: 1 (866) 538-9510
Fax: 1 (866) 539-0365