Molecular and Genomic Testing Program Update: March 2019

Horizon Blue Cross Blue Shield of New Jersey will implement changes to the services included as part of our Molecular and Genomic Testing Program, administered by eviCore healthcare (eviCore) for members enrolled in Horizon BCBSNJ fully-insured products as well as administrative services only (ASO) accounts that have elected the Molecular and Genomic Testing Program.

eviCore will conduct pre-service Medical Necessity Determination (MND) reviews of the additional diagnostic testing services represented by the codes below when rendered on and after March 1, 2019 in a physician’s office or clinical laboratory:¹

Effective January 1, 2019, eviCore will no longer conduct pre-service MND reviews of the services represented by the following codes as part of the Molecular and Genomic Testing Program.

Review the complete list of molecular and genomic diagnostic testing services that require pre-service MND reviews.

For more information about this specialty utilization management program, visit our Molecular and Genomic Testing Program web page. If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

¹ MND requirements will not apply to molecular and genomic diagnostic testing services rendered to patients in a hospital Emergency Room, hospital outpatient or inpatient setting or an Ambulatory Surgery Center (ASC).

CPT® is a registered trademark of the American Medical Association.

PRE-SERVICE MND REVIEWS

To obtain pre-service MND from eviCore (or to validate that a pre-service MND was requested and/or approved):

• Visit.eviCore.com; or
• Call 1-844-224-0493, between 7 a.m. and 7 p.m., Eastern Time.

Review the guidelines eviCore uses to conduct MND reviews as part of the Molecular and Genomic Testing Program