How it works

• Order request – Submit a genetic testing order request through our online Carelon Medical Benefits Management provider portal. Our system is designed to help guide your test and laboratory selection, and alert you to any genetic counseling requirements.
• Review – We evaluate your request with regards to:
  • Alignment with clinical guidelines and/or health plan medical policy
  • Satisfaction of genetic counseling requirements when required by applicable clinical criteria
  • Use of in-network laboratory
• Determination – When your request aligns with applicable clinical criteria, you will receive an immediate approval.

Access to clinical expertise

If your request does not meet clinical criteria, you will have the option of discussing your case with one of our clinical genetics experts. Frequently, more appropriate testing can be recommended for your patient. Sometimes, testing can be approved when additional clinical information is provided. A peer-to-peer discussion with one of our physician reviewers is always offered before any adverse determination is made.

Genetic counseling

If genetic counseling is required for the test you select, a list of providers who can deliver that service can be provided. While we make efforts to limit this list to encourage the use of in-network providers, please check with your patient’s health plan to verify network eligibility.

Program designs vary by health plan. We encourage you to review the FAQs for each patient’s plan on the Resources page.