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June 27, 2017

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.

Contact

Telligen

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