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.
following types of genetic testing are not
covered by Idaho Medicaid:
performed for screening purposes only, in the absence of signs, symptoms, or
personal history of disease or injury
that are done solely to diagnose a patient, and will not impact medical
decision-making for the patient or the patient’s treatment plan
performed for the purposes of genetic counseling or family planning
that do not meet the definition of medical necessity as set forth in IDAPA 16.03.09.011.16
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.