{"id":7,"date":"2018-10-31T13:13:49","date_gmt":"2018-10-31T18:13:49","guid":{"rendered":"https:\/\/providers.carelonmedicalbenefitsmanagement.com\/genetictesting\/?page_id=7"},"modified":"2022-12-06T13:52:36","modified_gmt":"2022-12-06T19:52:36","slug":"medical-policy-and-guidelines","status":"publish","type":"page","link":"https:\/\/providers.carelonmedicalbenefitsmanagement.com\/genetictesting\/about-the-program\/medical-policy-and-guidelines\/","title":{"rendered":"Medical policy and guidelines"},"content":{"rendered":"<p>Genetic testing requests are evaluated against evidence-based\u00a0<a href=\"http:\/\/www.aimspecialtyhealth.com\/CG-GeneticTesting.html\" target=\"_blank\" rel=\"noopener\">clinical appropriateness guidelines<\/a>\u00a0and\/or health plan medical policy, as required by each patient&#8217;s health plan.<\/p>\n<h3 class=\"mixed-case\">Clinical guideline development process<\/h3>\n<p>Carelon Medical Benefits Management will first apply any clinical criteria from the health plan, whether in the form of medical policy or clinical guidelines.\u00a0 In the event that the health plan does not have applicable clinical criteria, Carelon uses clinical appropriateness guidelines that are based on established, evidence-based criteria and developed in consultation with panels of academic thought leaders and community physicians from across the country. The process for assessing the clinical appropriateness of testing is consistent with the CDC ACCE Model Process for Evaluating Genetic Tests. Guidelines are formally reviewed and updated annually but may also be updated more frequently as needed based on the publication of new literature or supporting evidence. Our panelists meet and review evidence quarterly.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-36 aligncenter\" src=\"https:\/\/providers.carelonmedicalbenefitsmanagement.com\/genetictesting\/wp-content\/uploads\/sites\/15\/2018\/11\/cloud_v1.png\" alt=\"\" width=\"866\" height=\"537\" srcset=\"https:\/\/providers.carelonmedicalbenefitsmanagement.com\/genetictesting\/wp-content\/uploads\/sites\/15\/2018\/11\/cloud_v1.png 866w, https:\/\/providers.carelonmedicalbenefitsmanagement.com\/genetictesting\/wp-content\/uploads\/sites\/15\/2018\/11\/cloud_v1-300x186.png 300w, https:\/\/providers.carelonmedicalbenefitsmanagement.com\/genetictesting\/wp-content\/uploads\/sites\/15\/2018\/11\/cloud_v1-768x476.png 768w, https:\/\/providers.carelonmedicalbenefitsmanagement.com\/genetictesting\/wp-content\/uploads\/sites\/15\/2018\/11\/cloud_v1-358x221.png 358w\" sizes=\"auto, (max-width: 866px) 100vw, 866px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>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.<\/p>\n<p>Program designs vary by health plan. We encourage you to review the FAQs for each patient&#8217;s plan on the\u00a0<a href=\"https:\/\/providers.carelonmedicalbenefitsmanagement.com\/genetictesting\/program-resources\/\">Resources page<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Genetic testing requests are evaluated against evidence-based\u00a0clinical appropriateness guidelines\u00a0and\/or health plan medical policy, as required by each patient&#8217;s health plan&#8230;.<\/p>\n","protected":false},"author":13,"featured_media":0,"parent":5,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-7","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Carelon - 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