Get Supplemental Genetic Testing Prior Authorization Form - Mainecare Maine

This guide is designed to assist users in accurately completing the Supplemental Genetic Testing Prior Authorization Form for Mainecare Maine online. By following the steps outlined below, users can ensure that their submissions are thorough, clear, and aligned with the necessary requirements for authorization.

Follow the steps to effectively complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide the prior authorization number in the designated field. This reference number is essential for tracking the request.
3. Enter the member's name, ensuring the last name is first, followed by their first name.
4. Input the member's I.D. number to identify their account within the Mainecare system.
5. In the section asking for the necessity of the procedure, describe the medical diagnosis of the member. Use specific details to substantiate the need for genetic testing.
6. Complete the clinical justification statement by detailing the appropriateness of the test, comparing it with alternative options. Reference any medical, family, or psychosocial history that supports this choice.
7. Indicate whether the genetic testing service is necessary by checking the appropriate boxes for diagnostic testing, pre-symptomatic testing, pharmacogenetic testing, genetic carrier screening, or prenatal testing.
8. Confirm that the testing service is recognized as standard medical care and check the corresponding box.
9. If applicable, be prepared to provide a reference to peer-reviewed literature or guidelines supporting the genetic testing order as required.
10. Complete the attestation section by signing and dating the form. Include the printed name of the provider.
11. Once all fields are completed, save changes, then download, print, or share the form as required.

Complete your documents online today to ensure timely processing.