CommercialPrior AuthHigh impact
PAP219 - Carelon Authorization - Adding Genetic Testing to Carelon PA requirements.
Blue Cross of Idaho·ID·Prior Authorization
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho has added genetic testing to Carelon's prior authorization requirements. Providers must now obtain prior authorization through Carelon before providing genetic testing services to certain commercial and all Medicare Advantage members, with up to 7 days post-service for retrospective authorization.
Action Required
Immediately: Update scheduling and billing workflows to require prior authorization for all genetic testing procedures through Carelon (866-714-1105 or online portal). Train staff to verify authorization requirements using the Prior Authorization Procedure Code Lookup Tool before scheduling genetic testing. Include authorization numbers on all genetic testing claims. Failure to obtain prior authorization will result in claim denials.