Genetic Testing Management Partnership Implementation - Operations Update
Update #: OPSAVGTM120124
Effective Date: 12/1/2024 (See Implementation Timeline by Plan Type)
Applicable Plan(s): Commercial and Medicaid
Applicable Policy: N/A
Business Owner: Clinical Care Services
Current State: Administered by Sentara Health Plans
Future State: The Genetic Testing Management (GTM) program includes new and revised medical policies, a new authorization request process, guidelines, and consistent preservice reviews for certain genetic testing services that will be applicable to both ordering and rendering provider partners.
Avalon focuses on provider education both pre- and post-determination. Avalon reviews for medical necessity and focuses on correct coding by reviewing if the code appropriately represents the test being requested. If not, we attempt to educate the providers on those components. By combining both review processes, --medical necessity, and coding—we will ensure that the correct service is identified and determined to be clinically appropriate according to evidence-based specialty lab guidelines and best practices.
This change will be transparent to members.