The 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.
It (MolDX) remains intact and active. The Program Maintainer will continue to administer the Program and all its information.
The Contractor [for J-E MAC] shall enter into a JOA with the MolDx Program Maintainer for what responsibilities are that of the maintainer and the contractor, how they will interact, but not limited to all activities surrounding MolDx.
MolDx Program Maintainer
• Determinations regarding coverage
• Coordination with McKesson to establish a unique identification numbers
• Coordination and communication with Noridian on all claims processing guidelines
MolDx Jurisdiction Claims Administrator
• Implement MolDX guidelines provided by Palmetto GBA
• Process claims with Palmetto GBA guidelines
• Appeals/Reopenings for claims processing
• Continue to send new test documentation to Palmetto GBA
• Send Medicare claims to Noridian after the unique identifiers have been assigned
• Send policy and coverage questions to Palmetto at email@example.com
• Contact the Noridian Provider Contact Center with claims processing questions
• Submit Reopening/Appeals requests to Noridian