News

Effective May 1, 2022: New Payment Policy - Genetic and Molecular Testing Services

Date: 01/28/22

Superior HealthPlan presents a new payment policy to communicate the expanded requirements for billing of molecular and genetic testing to advance the reliability of laboratory quality information and reduce variability in billing. As a result, the following policy has been added, and is posted on Superior’s Clinical, Payment and Pharmacy Policies website for review, prior to its implementation:

POLICY	EFFECTIVE DATE	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Genetic and Molecular Testing Services TX.PP.551	05/01/2022	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan, Medicare (Wellcare By Allwell[ HMO,HMO D-SNP]	To verify the accuracy of a test catalog and review coding engine standards for each molecular and genetic test, laboratories billing for genetic and molecular testing services should register using the Concert Genetics portal at https://www.concertgenetics.com/join-superior. The portal offers a quality metrics questionnaire for completion by laboratories that leverages industry-standard quality programs with customization to reflect the unique characteristics of genetic testing while being minimally burdensome on providers. Laboratories can also utilize the Concert Portal to obtain and access the Genetic Testing Unit (GTU), a unique identifier for every genetic test for billing and payment.

POLICY

EFFECTIVE DATE

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Genetic and Molecular Testing Services

TX.PP.551

05/01/2022

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan, Medicare (Wellcare By Allwell[ HMO,HMO D-SNP]

To verify the accuracy of a test catalog and review coding engine standards for each molecular and genetic test, laboratories billing for genetic and molecular testing services should register using the Concert Genetics portal at https://www.concertgenetics.com/join-superior.
The portal offers a quality metrics questionnaire for completion by laboratories that leverages industry-standard quality programs with customization to reflect the unique characteristics of genetic testing while being minimally burdensome on providers.
Laboratories can also utilize the Concert Portal to obtain and access the Genetic Testing Unit (GTU), a unique identifier for every genetic test for billing and payment.

To review all payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Superior Provider Services at:

1-877-391-5921 (Medicaid [STAR, STAR Health, STAR Kids, STAR+PLUS], CHIP, Wellcare By Allwell [HMO, HMO SNP])
1-877-687-1196 (Ambetter from Superior HealthPlan)