As a reminder, Point32Health requires prior authorization for coverage of all prenatal testing, including noninvasive prenatal testing (NIPT).
When requesting authorization, keep in mind the following process distinctions depending on the member’s product:
For Harvard Pilgrim Health Care (Commercial and StrideSM [HMO]/[HMO-POS] Medicare Advantage) and Tufts Health Public Plans products, our genetic testing and molecular diagnostic management authorization program is managed through an arrangement with Carelon. You can find their clinical criteria and other resources on this Point32Health-specific microsite. (Criteria for NIPT are included under the “Carrier screening in the reproductive setting” guideline.)
To request prior authorization for genetic testing such as NIPT or other prenatal testing for Harvard Pilgrim and Tufts Health Public Plans members, providers should use Carelon’s online provider portal or call the applicable number below:
- Harvard Pilgrim: 855-574-6476
- Tufts Health Plan: 833-342-1255
For Tufts Health Plan Commercial members, you can request authorization directly through Point32Health the way you usually do, and clinical criteria can be found in our Genetic Testing – Prenatal Diagnosis and Carrier Screening Medical Necessity Guidelines.
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