Prior Authorization Information

Prior authorization is a process used by many insurance copanies to determine if a procedure, service, or medication will be covered. Most insurance companies are now requiring prior authorization for certain genetic and molecular laboratory testing.

Prior Authorization Process

1. Complete the following form:  Prior Authorization Request Form. 
2. Include a legible copy of the front and back of the patient’s insurance card
3. Send relevant clinic notes (i.e. ultrasound report, pathology reports, office visits, genetic counseling notes, previous testing, etc.)
4. Send above information to our Billing Support team by:
   • rpsbillingsupport@unmc.edu  |  fax (402-559-8359)

What to expect after submitting a request?

• An 'Insurance Authorization Update' will be sent in nealry all cases to the ordering provider (by the method designated in section D of the prior auth form).
  • Testing automatically proceeds if the out of pocket setimate is $100 or less and the specimen has been received by the laboratory.
• The provider/ordering facility is responsible for coordinating specimen collection and shipment to our laboratory after authorization update has been communicated.

• An 'Insurance Authorization Update' will be sent in nealry all cases to the ordering provider (by the method designated in section D of the prior auth form).
  • Testing automatically proceeds if the out of pocket setimate is $100 or less and the specimen has been received by the laboratory.
• The provider/ordering facility is responsible for coordinating specimen collection and shipment to our laboratory after authorization update has been communicated.

What to do if prior authorization is denied or testing is not a covered benefit?

Even if prior authorization is denied or an insurance policy excludes the service for your patient, the patient may still seek testing but will be responsible for the cost of testing.  Please also submit the Patient Consent for Non-Covered Lab Services Form. RPS offers financial assistance for patients who meet criteria and you can reach out to our billing team to review payment options.

Common Testing Requiring Prior Authorization:

Please note this is not an all-inclusive list of tests that require prior authorization or have limited coverge. The patient's insurance company should be contacted for plan specific details.