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December 12, 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 Medicaid Fee Schedule shows which labs always require a prior authorization, and which organization will review your request.

March 12, 2018 - Update

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

These codes will still be reviewed by the Medical Care Unit.

81225  Cyp2c19 gene analysis common variants
81226  Cyp2d6 gene analysis common variants
81227  Cyp2c9 gene analysis common variants
81355  Vkorc1 gene analysis common variants  

Medical Care Unit Authorizations

Prior authorizations that are not reviewed by Telligen should be faxed to the Medical Care Unit at 1 (877) 314-8779 on the Genetic Lab Request Form. Please, include proof of medical necessity with your request. Requests are only accepted by fax.

The status of a prior authorization request may be checked online at the DXC Technology portal under “Authorization Status”, using your NPI, or by contacting DXC Technology at 1 (866) 686-4272. If you have questions on a Denial, click on the Notes, which will explain the reason for the Denial, or ask the DXC Technology Customer Service Representative to read you the Notes in the Denial.

For other questions or general information, contact 1 (866) 205-7403.

Telligen, Inc. Authorizations

Prior authorization requests through Telligen, Inc. may be submitted: 

 

Online:
Fax:
Mail: 
Telligen provider portal 
1 (800) 826-3836
Telligen
670 East Riverpark Lane, Suite 170
Boise, ID 83706

 

The status of a prior authorization request may be checked online at the provider portal, or by contacting Telligen, Inc. at 1 (866) 538-9510.

Please, contact Telligen, Inc. at 1 (866) 538-9510 if you require additional information or assistance.

Contact

Medical Care Unit

Phone: 1 (866) 205-7403
Fax: 1 (877) 314-8779
Email:
MedicalCareUnit@dhw.idaho.gov


Telligen, Inc.

ATTN: Prior Authorizations
670 East Riverpark Lane, Suite 170
Boise, ID 83706
Phone: 1 (866) 538-9510
Fax: 1 (866) 539-0365