How it works

• Order request – Submit a review request through the Carelon Medical Benefits Management provider portal.
  Our system is designed to help guide your test and laboratory selection, and alert you to any genetic counseling requirements.
• Review – We evaluate your request with regards to:
  • Alignment with Carelon evidence-based clinical guidelines
  • Utilization of an in-network laboratory (if required by plan)
• Determination – When your request aligns with applicable criteria, you will receive an immediate approval

Access to clinical expertise

If your request does not meet clinical criteria, you will have the option of discussing your case with one of our clinical genetics experts. Sometimes, testing can be approved when additional clinical information is provided. Other times, testing aligned with criteria can be recommended for your patient. A peer-to-peer discussion with one of our physician reviewers is always offered before any adverse determination is made.

Genetic counseling

If genetic counseling is recommended for the test you select, and has not been performed, we can provide access to a list of genetic counseling providers, including local in-person providers and telephonic counseling providers if requested. Verification of a genetic counseling provider’s network eligibility is encouraged.