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Starting Nov. 1, 2017 - UHC Members Require Prior Authorization for Genetic & Molecular Lab Testing

Prior Authorization Process Prior Authorization Info Prior Authorization FAQS

Starting November 1, 2017, UnitedHealthcare (UHC) is requiring a Notification and Prior Authorization for all genetic and molecular lab tests. This new process being implemented by UHC affects all UHC Commercial plan members*. This means that you will need to request notification/prior authorization for each individual order code through this new process before the lab test can be processed and reimbursed. 
 
To help simplify the process, Enzo has registered our lab with UHC.  Our lab information and associated test codes have been populated in their database. You can select them directly in the system during the pre-authorization process.
 
What you will need to do:
  • Go to www.uhcprovider.com
  • Select the genetic and molecular test application
  • Login, first time users will need to sign up 
    • First time registration for physicians will need to enter: Email, Last name, First name, NPI Number (NPI auto-populations additional data)
    • Enter the Tax ID Number
  • Once you are login, enter subscriber number (policy number) or the members last name, first name, and date of birth
  • Click search members
  • Select practice location
  • At physician: enter name or NPI of the ordering provider
  • Enter collection date
  • Add diagnosis code (Type in diagnosis code, ICD-10, or description search)
  • Under Test(s) and Panel(s), enter lab name: Enzo Clinical Labs
  • For prior authorization requests, enter an email and phone number (Decision rendered email for prior authorization approval goes to this email and phone number)
  • System will ask clinical questions, if applicable, click and continue
  • A status message will be shown of Criteria Met or Criteria Not Met (Pop-up blockers need to be DISABLED to receive the preliminary summary screen), which will provide the official authorization number within 10 minutes
    • Criteria Not Met allows you to select and send other clinical information to UHC, then click submit (preauthorization pending clinical review)
  • A print-out of the outcome summary should be sent to Enzo Clinical Labs (e.g. with requisition form)
 
To find the status of previous requests, click on the menu option at the top, Manage (or Completed Notifications).
 
To learn more about UHC’s new process for genetic and molecular testing, please contact your local Enzo rep or go online to
https://www.uhcprovider.com/en/prior-auth-advance-notification/genetic-molecular-lab.html.

We are here to help! Contact us at 1.800.371.5227.
 
*Exceptions include: Neighborhood Health Partnership; Sierra; UnitedHealthcare of the Mid-Atlantic; UnitedHealthcare Oxford; UnitedHealthcare of the River Valley; UnitedHealthcare West; UnitedHealthOne.