CommercialPrior AuthHigh impact
HealthHelp to Manage Molecular Lab Prior Authorization
Highmark·DE, PA, WV, NY · Genetics, Cardiology, Oncology +4 more·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Jun 26, 2026
Summary
Effective October 1, 2026, HealthHelp will assume management of prior authorizations for genetic and molecular lab testing across Highmark regions. In Delaware, Pennsylvania, and West Virginia, HealthHelp replaces eviCore with expanded code coverage. In New York, prior authorization requirements are being introduced for the first time for a broad range of genetic/molecular lab tests. Providers must submit requests through Availity Essentials and complete the authorization process via HealthHelp's portal with potential peer-to-peer review by genetic counselors.
Action Required
By September 15, 2026: (1) Billing team must identify all genetic and molecular lab testing CPT/HCPCS codes currently billed to Highmark members in DE, PA, WV, and NY regions and flag those requiring new prior authorization starting Oct 1. (2) Update billing software and encounter templates to require prior authorization initiation in Availity Essentials for molecular lab tests, with instructions to complete submission via HealthHelp portal using single sign-on (SSO). (3) Train billing and provider staff on the new two-step submission process (Availity → HealthHelp portal) and inform providers that re-entry of member/provider information may be required during transition. (4) Establish internal protocol for managing peer-to-peer consultations with HealthHelp genetic counselors when authorization requests are under review. (5) Configure billing system to check authorization status via HealthHelp WebConsult page using member ID, tracking number, or authorization number. (6) Register staff for HealthHelp virtual training webinars (dates forthcoming). Failure to obtain prior authorization for affected molecular lab services will result in claim denials. Note: Full list of affected prior authorization codes will be provided in upcoming communications—monitor for supplemental bulletins.