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HealthHelp to Manage Molecular Lab Prior Authorization
Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
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.
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What to do
by Sep 15, 2026 · 8 steps
01Billing 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.
02Update 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).
03Train 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.
04Establish internal protocol for managing peer-to-peer consultations with HealthHelp genetic counselors when authorization requests are under review.
05Configure billing system to check authorization status via HealthHelp WebConsult page using member ID, tracking number, or authorization number.
06Register staff for HealthHelp virtual training webinars (dates forthcoming).
07Failure to obtain prior authorization for affected molecular lab services will result in claim denials.
08Note: Full list of affected prior authorization codes will be provided in upcoming communications—monitor for supplemental bulletins.
Original notice
HealthHelp to Manage Molecular Lab Prior Authorization
providers.highmark.com · Always check the source before changing claims.
Related changes
See all Highmark changes →Genetic/Molecular Lab Testing to Require Authorization in NY Starting Nov. 1HighEffective Nov 1, 2026 · Provider BulletinHealthHelp Transition: Training Sign-Up, Prior Auth Code List, and NY UpdateHighEffective Oct 1, 2026 · Prior AuthorizationHealthHelp Transition: Sign Up for Molecular Lab Prior Auth TrainingHighEffective Oct 1, 2026 · Prior AuthorizationBrowse every Highmark change in the policy list