Medical Policy and Clinical Guidelines
Genetic testing requests are evaluated against evidence-based clinical appropriateness guidelines and/or health plan medical policy, as required by each patient’s health plan.
Clinical guideline development process
AIM will first apply any clinical criteria from the health plan, whether in the form of medical policy or clinical guidelines. In the event that the health plan does not have applicable clinical criteria, AIM uses clinical appropriateness guidelines that have been created by Informed DNA (IDNA). IDNA board-certified genetic counselors and medical geneticists developed the clinical guidelines through systematic reviews of peer-reviewed resources, medical society guidelines and practice bulletins. The process for assessing the clinical appropriateness of testing is consistent with the CDC ACCE Model Process for Evaluating Genetic Tests. Guidelines are reviewed and updated at least quarterly – more frequently if necessitated by new evidence.
Genetic testing requests may be submitted by providers with varying medical specialties. The categories of genetic testing and medical specialties impacted by the program may vary from health plan to health plan.
Program designs vary by health plan. We encourage you to review the FAQs for each patient’s plan on the Resources page.