Promoting and protecting the health and safety of all Idahoans

Laboratory Services

Idaho Medicaid coverage includes laboratory and 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. Screening services are covered as mandated by the Affordable Care Act (ACA) and recommended by the US Preventive Services Task Force (USPSTF) with an “A” or “B” recommendation, or when listed in the American Academy of Pediatrics Bright Futures periodicity schedule.

The following types of laboratory and pathology services 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 without an “A” or “B” recommendation from the USPSTF or on the Bright Futures periodicity schedule.

  • 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 Numerical Fee Schedule shows which labs always require a prior authorization, and which organization will review your request.

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 Laboratory Prior Authorization 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.