Effective April 1st 2017, all HUSKY Health genetic testing medical policies will be retired. McKesson’s InterQual® Molecular Diagnostics Criteria will instead be used in conjunction with the Department of Social Services (DSS) definition of Medical Necessity. The criteria provide evidence-based clinical decision support for molecular and genetic tests. While there will be no change to the prior authorization submission process itself, more detailed information will be required to facilitate person-centered, medical necessity determinations that will support high quality, cost-effective outcomes. Clinical validity, utility, and efficacy will all be considered in determining if the test being requested is medically appropriate.
The following are examples of documentation that will be required from the ordering provider as part of the medical necessity review process:
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