Developmental Delay/Intellectual Disability — Financial Clearance, Genetic Testing — Clinical Pathway: Primary Care

Developmental Delay/Intellectual Disability Diagnostic Evaluation Clinical Pathway — Primary Care

Financial Clearance and Authorization for Genetic Testing

Use the following process to connect with a financial counselor to obtain authorization for genetic testing.

  1. Ordering clinician creates Care Coordination or Orders Only encounter and places “Consult to Genetic Testing” order.
    • Clinician must include CPT and ICD-10 codes and lab details (test and lab name) in the Comments section of the consult order.
  2. Financial counselor will submit clinical notes and letter of medical necessity to begin the authorization process.
    • Authorization process typically takes 2-6 weeks.
    • Ordering clinician can review order status by clicking on “Referrals” or “Other Orders” in Chart Review.
  3. If approved, the financial counselor will request a cost estimate to determine out-of-pocket payment for the family. A financial counselor will contact the family regarding the cost.
  4. Financial counselor then sends staff message to the ordering clinician with the determination status.
  5. If denial is received, a staff message will be sent with peer-to-peer information, if available.
  6. Once insurance approval is obtained and financial information is reviewed with the family, the ordering clinician can then place the order for the genetic test.