Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways

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Current Genetic Testing Guidelines

The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. Carelon Clinical Appropriateness Guidelines for Genetic Testing are developed through a rigorous process integrating evidence-based literature with expert review.

The guidelines do not address coverage, benefit or other plan specific issues. Applicable federal and state coverage mandates take precedence over these clinical guidelines. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon guidelines.

Please use this form to submit comments and recommendations about the Carelon Genetic Testing Clinical Appropriateness Guidelines.