Genetic Testing Basics
This type of test analyzes DNA to identify inherited conditions or disease risk.
What is genetic testing?
This Natera test evaluates inherited cancer risk using a multi-gene panel.
What is the Empower™ hereditary cancer test?
The first action taken after an Empower denial is received.
What is reviewing the denial reason?
The denial you get when the chart says “family history: unknown” and nothing else.
What is insufficient documentation?
This medical professional often reviews genetic test orders for medical necessity.
What is a genetic counselor?
Empower testing is designed to identify risk for this type of cancer-related condition.
What is hereditary cancer?
This payer rule determines how long you have to appeal.
What is the appeal timeframe?
This denial appears when an Empower test is ordered “just to be safe” with no qualifying risk factors.
What is lack of medical necessity?
The policy requirement that determines whether a genetic test is covered based on diagnosis and guidelines.
What is medical necessity?
This type of DNA sample is commonly used for the Empower test.
What is a blood or saliva sample?
Empower appeals are stronger when this specialist’s input is included.
What is a genetic counselor?
When the diagnosis code and the Empower test clearly aren’t on the same page, payers issue this denial.
What is an ICD-10 mismatch?
The document that explains coverage criteria, limitations, and exclusions for genetic testing.
What is a payer medical policy?
Empower is considered this type of genetic test when used appropriately.
What is diagnostic genetic testing?
Submitting this can help support medical necessity.
What is family history documentation? , REq & Report will be accepted
This denial shows up when the payer wanted permission before the test—but never got it.
What is no prior authorization?
This denial happens when the Empower test meets clinical criteria—but the paperwork didn’t make it into the chart.
What is missing clinical documentation?
This type of test is often denied when ordered without appropriate clinical indications.
What is predictive or screening genetic testing?
Empower tests are typically ordered by this type of healthcare provider.
What is a physician or qualified healthcare provider?
This type of appeal review is requested after internal appeals are exhausted.
What is an external appeal?
The denial that happens when a large gene panel is ordered but the patient doesn’t meet criteria for it.
What is over-testing or panel size not justified?
The denial that happens when a large gene panel is ordered but the patient doesn’t meet criteria for it.
What is over-testing or panel size not justified?