Effective March 1, 2024: Prior Authorization for Certain Genetic Tests

Date: 11/17/23

Superior HealthPlan will require prior authorization for certain genetic testing for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP) and Marketplace (Ambetter from Superior HealthPlan) members. Prior authorization requests should be submitted to National Imaging Associates, Inc. (NIA). This prior authorization update is effective March 1, 2024.

Prior authorization requests can be submitted  www.RadMD.com, by calling 1-800-642-7554 or fax 1-800-784-6864.

NIA’s Genetic and Molecular Testing Guidelines can be found at www.RadMD.com, they are presented in a PDF file format that can easily be printed for future reference. NIA’s clinical guidelines have been developed from practice experiences, literature reviews, specialty criteria sets and evidence-based research.

NIA: Genetic and Molecular Testing Quick Reference Guide (QRG)

Superior ensures medical necessity review criteria are current and appropriate for members and the scope of services provided.

Genetic Test Groups	Genetic Test Categories
Cardiac Disorders	Comprehensive Arrhythmia & Cardiomyopathy Panel Tests
Metabolic/Mitochondrial Disorders	Mitochondrial DNA (mtDNA) Sequencing Panel Tests
	Mitochondrial Disease (including Nuclear Genes) Panel Tests
Intellectual Disability/Developmental Delay	Autism Spectrum Disorder/Intellectual Disability Panel Tests
	X-Linked Intellectual Disability Panel Tests
Transplant	Post Heart Transplant Gene Expression Panels for Rejection Risk
Pharmacogenetic	Pharmacogenetic Neuropsychiatric Panel Tests
Oncology	Cell-Free Circulating Tumor DNA Colorectal Cancer Panel Tests
	Cell-Free Circulating Tumor DNA Lung Cancer Panel Tests
	Lung Cancer Panel Tests
	Tumor Specific BCR/ABL Quantitation and Breakpoint Analysis Tests
	Bladder Cancer Diagnostic and Recurrence Algorithmic Tests
	Lung Cancer Diagnostic Algorithmic Tests
	Lung Cancer Treatment Algorithmic Tests
	Colorectal Cancer Prognostic Algorithmic Tests

To review prior authorization requirements, please visit www.RadMD.com.

To review NIA policies, please visit NIA's Genetic Testing Management webpage.

For questions or additional information, contact Superior's Prior Authorization department at 1-800-218-7508.