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HealthHelp Transition: Sign Up for Molecular Lab Prior Auth Training
Highmark·DE, PA, WV, NY · Genetics, Pathology·Prior Authorization
Effective date
Oct 1, 2026
We identified it
Jul 28, 2026
Summary
HealthHelp will replace eviCore as the prior authorization vendor for genetic/molecular lab testing across Highmark's four-state footprint effective October 1, 2026. Providers must submit initial requests via Availity Essentials, then route to HealthHelp's portal via single sign-on. New prior authorization requirements will expand significantly in New York and other regions.
Action Required
By September 15, 2026: All providers billing for genetic/molecular lab testing must complete mandatory HealthHelp prior authorization training. Register for one of two sessions (Sept 15, 9-10 a.m. EST or Sept 18, 12-1 p.m. EST) at the registration link provided. Before October 1, 2026: Update billing workflows to route genetic/molecular lab authorization requests through Availity Essentials to HealthHelp portal via Predictal SSO instead of eviCore. Billing team must be prepared for re-entry of member and provider information in HealthHelp's portal during transition. Implement system changes to capture expanded genetic/molecular lab codes now requiring prior authorization in DE, PA, WV, and NY. Failure to obtain prior authorization from HealthHelp for covered codes will result in claim denials effective October 1, 2026.