Claims match enhancement for Carelon Medical Benefits Management, Inc. Genetic Testing

As part of our ongoing quality improvement efforts, we will be implementing a new Genetic Testing (GT) claim to authorization match enhancement that will ensure GT panels billed have a corresponding authorization. This enhanced match logic will be effective by May 1, 2024. Labs that bill panels with codes in excess of what has been authorized may receive a full claim denial. The goal of this enhanced match logic is to ensure tests performed are authorized and meet medical necessity requirements.