Genetic/Molecular Lab Testing to Require Authorization in NY Starting Nov. 1

Effective Nov. 1, 2026, HealthHelp will manage authorizations for genetic/molecular laboratory testing in New York.

Providers will need to submit initial authorization requests for genetic/molecular lab tests via Availity Essentials, Highmark’s provider portal. Once the initial auth request is submitted in Availity, providers will be routed via Predictal to HealthHelp’s auth portal by single sign-on (SSO) to continue the submission process.

Types of molecular lab tests that HealthHelp will manage include:

• Cardiovascular disease and thrombosis risk variant testing
• Carrier screening tests
• Hereditary cancer screening
• Hereditary cardiac disorders
• Intellectual disability/developmental disorders
• Mitochondrial disease testing
• Neurologic disorders
• Pharmacogenomic testing
• Tumor marker/molecular profiling

This authorization requirement will apply to your patients who are covered by Highmark’s Commercial fully insured, Medicare Advantage, and ACA plans.

Background

As a reminder, Highmark is engaging HealthHelp, a specialty benefit management company, to assist Highmark in applying evidence-based medical criteria and expert peer consultation to ensure appropriate utilization of molecular lab services.

HealthHelp Resources

• Training Session: To ensure a smooth transition, we encourage providers to sign up for the upcoming HealthHelp training session on October 27 at 9 a.m. This session will provide essential information on the new authorization process.
• Landing Page: To further help you and your office prepare for the Nov. 1 implementation, HealthHelp has a dedicated landing page for Highmark providers. This page includes the prior authorization code list and frequently asked questions (FAQs) that will help you navigate the new system. We encourage you to review the code list and FAQs prior to Nov. 1.