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MolDX

The Molecular Diagnostic Services (MolDX) Program was developed by Palmetto GBA in 2011 to identify and establish coverage and reimbursement for molecular diagnostic tests. This program performs the following functions.

  • Facilitates detailed and unique identification through registration of molecular diagnostic tests to facilitate claims processing and to track utilization.
  • Establishes clinical utility expectations.
  • Completes technical assessments of published test data to determine clinical utility and coverage.
  • Establishes reimbursement.

Palmetto GBA currently administers the MolDX Program and all its information.

Topic Brief Description
Active LCDs View all active Local Coverage Determinations (LCDs)
Covered Tests View MolDX LCDs and LCD Articles
Draft LCDs View all draft LCDs
Excluded Tests View MolDx tests excluded from coverage
Future LCDs View all future LCDs

 

MolDX - Responsibilities

MolDX Contractor

  • Determinations regarding coverage
  • Pricing
  • Coordination with McKesson to establish a unique identification numbers
  • Coordination/communication with Noridian on all claims processing guidelines

Noridian

  • Implement MolDX guidelines in cooperation with MolDX contractor
  • Process claims using MolDX guidelines
  • Conduct Appeals/Reopenings for claims processing for Noridian providers

Providers in Noridian's Jurisdictions

  • Continue to send new test documentation in regards to coverage consideration to MolDX contractor
  • Submit claims to Noridian after unique identifiers have been assigned
  • Send policy/coverage questions to Palmetto at moldx@palmettogba.com
  • Contact Noridian Provider Contact Center with claims processing questions
  • Submit Reopening/Appeals requests to Noridian

Last Updated Sep 29, 2015