HealthHelp to Manage Molecular Lab Prior Authorization

Beginning Oct. 1, 2026, HealthHelp will manage prior authorizations for genetic/molecular lab testing.

HealthHelp, a specialty benefit management company, will apply evidence-based medical criteria and expert peer consultation to ensure appropriate utilization of molecular lab services.

Regional Impact

• Delaware, Pennsylvania, and West Virginia – HealthHelp is replacing eviCore, the vendor that currently manages prior authorizations for lab services. The majority of prior authorization codes currently managed by eviCore will be managed by HealthHelp. Due to this transition, additional genetic/molecular lab management codes will require prior authorization, effective Oct. 1.
• New York – Currently, most genetic/molecular lab testing services do not require prior authorization. Beginning Oct. 1, the requirement for prior authorization will be expanded to include a broad range of genetic/molecular lab testing codes.

What This Means for Providers

Types of molecular lab tests that HealthHelp will manage include:

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

We will share the full list of prior authorization codes in an upcoming communication.

Lines of Business

Highmark members included in HealthHelp’s authorization reviews are:

• Commercial fully insured; Affordable Care Act (ACA); Medicare Advantage
• Self-funded Administrative Services Only (ASO) members in Delaware, Pennsylvania, and West Virginia
• Child Health Insurance Program (CHIP) members in Pennsylvania

Submission Process

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

Note: During the initial transition period, you may be asked to re-enter some member and provider information in HealthHelp’s authorization portal. We recognize the importance of a smooth experience and are actively working to simplify and improve the intake process.

Genetic Counselor Available

HealthHelp provides a consultative, educational authorization program that improves quality and reduces the cost of care.

In some cases, if the requested service does not meet evidence-based guidelines, Highmark ordering providers may be contacted by a HealthHelp genetic counselor to conduct a pre-service, peer-to-peer review to evaluate medical necessity and, potentially, alternative treatment and testing pathways before an authorization determination is made.

Checking Authorization Status

You can check the status of a prior authorization through the Highmark provider portal by navigating to the HealthHelp WebConsult page and clicking the Request Status link. You can search by member ID, tracking number, or authorization number.

Training and Support

To assist providers, HealthHelp will be offering virtual training webinars. Dates and registration links will be shared in upcoming communications.

We understand that changes to administrative processes can require adjustment, and we are committed to supporting you through this transition. We will provide additional communications and resources as we approach the Oct. 1 effective date.