New Genetic Testing Authorization Process with HealthHelp

Effective January 1, 2025, CDPHP is proud to team up with HealthHelp as our new genetic testing management vendor. This new collaboration will enhance the provider experience, streamline the prior authorization (PA) process, and help deliver high-quality, personalized care to our members.

Transition Details: What Providers Need to Know

To ensure a smooth transition, here’s what you need to know about switching from Avalon to HealthHelp for genetic testing PAs:

1. For Samples Collected in December 2024:
   • Submit prior authorization requests through Avalon.
   • The date of service is based on the sample collection date (e.g., blood draw or tissue collection), not when it’s sent to the lab or evaluated.
   • Requests must be submitted within 30 days of the collection date.
2. For Samples Collected on or After January 1, 2025:
   • Submit all prior authorization requests to HealthHelp via the CDPHP provider portal.
   • The 30-day submission window remains in place.
3. Access to Avalon Authorizations:
   • Providers can view prior authorizations submitted through Avalon in view-only mode until April 1, 2025 (date subject to change).

Submitting Prior Authorizations to HealthHelp

Starting January 1, 2025, providers can submit genetic testing PAs through the following channels:

• WebConsult Tool: Accessible through the CDPHP provider portal for the fastest processing.
• Phone: 1-888-673-7038
• Fax: 844-470-2456

Why HealthHelp is the Right Partner for Today’s Genetic Testing Needs

There’s no area of medicine evolving as rapidly as genetics. Advances in genetic testing open new doors to personalized medicine, helping patients get precise diagnoses and treatments tailored to their unique needs. With these rapid advancements, it’s critical to work with a vendor that is both clinically robust and provider friendly. That’s why CDPHP has selected HealthHelp, a treatment-focused partner that combines expert guidance, evidence-based criteria, and a patient-centered approach to manage genetic testing requests.

What Sets HealthHelp Apart?

HealthHelp’s comprehensive approach ensures that providers have the tools and support they need to navigate the ever-changing landscape of genetic testing. Here’s how HealthHelp makes a difference:

• Expert Guidance for Providers
  HealthHelp employs board-certified genetic counselors who collaborate with providers to analyze cases and recommend the most appropriate genetic tests for each patient.
• Evidence-Based Decision Making
  Using established guidelines and clinical data, HealthHelp ensures that every genetic test ordered is necessary and aligned with the latest medical evidence. This approach reduces unnecessary testing while improving the quality of care.
• Streamlined Preauthorization Support
  HealthHelp’s automated system simplifies the prior authorization process, helping providers navigate requests quickly and efficiently. This saves time and reduces administrative burdens, enabling providers to focus on patient care.
• Quality Control You Can Trust
  HealthHelp actively monitors and reviews genetic testing requests to uphold high standards of care. By minimizing inappropriate testing, they help ensure that patients receive only the most appropriate tests for their needs.
• Patient-Centered Care
  With a consultative approach, HealthHelp ensures that every genetic test ordered is personalized to meet the individual needs of each patient. This leads to more accurate diagnoses, optimized treatment plans, and better health outcomes.

This new collaboration with HealthHelp reflects our dedication to optimizing care for our members while ensuring providers have the support they need. We’re excited about the improvements this change will bring and appreciate your cooperation during the transition.

Questions? CDPHP is here to support you every step of the way. Contact Provider Services at (518) 641-3500 or 800-926-7526.