SMA Insurance Providers

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Acceptable SMA Insurance Guidelines 2024

  • Aetna Nationwide – ALL products (HMO, PPO, EPO, Medicare; No Capitation Products)
  • Aetna Better Health – (In Network States: VA, WV, LA, KY)
  • Allied Benefit Systems, Inc
  • Amerigroup (In Network State of NJ, MD, GA)
  • Amerigroup / Healthy Blue – (In Network Provider State of LA)
  • Amerihealth Administrators PPO (Blood & Tox only)
  • Amerihealth Caritas North Carolina
  • Amerihealth PPO, POS, HMO (Blood & Tox only)
  • BCBS of Arizona – ALL products (HMO, PPO, POS, Medi/Medi)
  • BCBS of Texas – ALL products (HMO, PPO, POS, Medi/Medi)
  • BCBS of Illinois Comminity Plan (In Network State of IL)
  • BCBS: Designated Blue Choice & Exchange Professional (PPO IL)
  • BCBS: Preferred Provider Option (PPO, In Network State of IL)
  • BCBS of Tennessee / Blue Network P/S/E/L – PPO, EPO, POS, HMO
  • BlueCare and BlueCare Plus (HMO, In Network State of TN)
  • Blue Advantage MA ( Medicare Advantage PPO, In Network State of TN)
  • Buckeye Community Health Plan -(In Network State of OH)
  • Capital Blue Cross / AVALON (In Network State of PA)
  • Care First Ppo Only – (In Network Provider State of MD, VA, DC)
  • Care First BCBS – Medicare Advantage, PPO (In Network State of MD)
  • CareSourse (In Network State of OH, GA, AR, KY, WV)
  • Cigna Healthcare – (In Network – All Products – Nationwide)
  • Cigna Healthspring
  • Clear Spring Health (In Network State of IL)
  • Cofinity
  • CoreSource
  • Federal BC/BS
  • Harmony Health Plan (In Network Provider -State of IL HMO)
  • Health Partners Plans (All products; In Network State of PA)
  • Highmark BC/BS PPO, POS, EPO
  • Humana PPO, Medicare
  • Independence Administrators
  • Independence BC/BS-Personal choice, Personal choice 65 (Blood & Tox only)
  • Jefferson Health Plans (All products: In Network State of PA)
  • Loomis Company of PA (IN-NETWORK PROVIDER)
  • Louisiana Healthcare Connections (In Network State of LA)
  • MagnaCare (Except Oscar)
  • Maryland Physicians Care, HMO (In Network State of MD)
  • Medicaid Straight (In Network Provider State of PA, NJ, MD, FL, WI, GA, VA, WV, MS, KY, OH, AL, AR, LA, CO, TX, NC, SC, WA, CA,TN ,IN, AZ, KS, VT, IL, MI, MO)
  • Medi-Cal – California Medicaid
  • Medicare Any State
  • Meritain Health
  • Molina Healthcare – (In Network States: OH, WA, TX)
  • Neighborhood, Part of BCBS of AZ (In Network Provider State of AZ)
  • Passport by Molina – (In Network State of KY)
  • Peach Tree Health Plan – (In Network Provider State of GA)
  • Sonder Health Plans
  • Sunshine Health – Medicaid-HMO
  • Superior Healthplan – (In Network Provider State of TX)
  • TennCare Select (HMO, In Network State of TN)
  • Tricare: North- HealthNet; South- Humana; West-Triwest
  • Troy Medicare
  • United Healthcare Community Plan of PA – (In Network PA)
  • Virginia Premier Health Plan -(In Network State of VA)
  • Vibra Health Plan (Medicare Advantage-PA)
  • Web TPA
  • WellCare – (In Network State of GA, KY, IL, NC, FL)
  • WellCare (Part of Sunshine Health) Medicare Advantage- PPO, HMO, D-SNP (Dual Medi/Medi)
  • Wellpoint / Amerigroup of TN (HMO, In Network TN)
  • 1199/SEIU – Part of Medco/Multiplan Only
  • Alicare PPO, POS, HMO
  • Anthem BCBS PPO Only
  • Assurant Health/ Fortis
  • BC/BS any state PPO Only
  • Clover Health
  • Connecticare
  • Corvel
  • Empire BC/BS— PPO, POS
  • Evergreen Health
  • Fallon Preferred Care
  • GHI- through Multiplan or GHI Network Access
  • Gallagher Basset Services Inc.
  • Great-West Healthcare
  • Health Care Partners (Except PA)
  • Health Republic Insurance Of NY
  • Horizon BC/BS- PPO Only (benefits vary based on plan type)
  • Intergroup Advantage Network
  • Key Benefit Administrators
  • Medical Mutual Of Ohio
  • Motor Vehicle Insurances
  • Ohio PPO Connect
  • POMCO
  • PacifiCare
  • Palmetto GBA (Railroad Medicare) National
  • Personal Injury/Workman’s Compensation
  • Prairie States Enterprises, Inc.
  • Presbyterian Health Plan
  • United Healthcare Medicare
  • WEA Trust
  • WEB TPA
  • WPS Health Insurance
  • First Health Network
  • PHCS Network
  • Multiplan Network

ComprehensiveDx Clear™

ComprehensiveDx Clear™
Test Code: 1248
Test Description ComprehensiveDx Clear is a comprehensive panel for hereditary breast, ovarian, uterine, colorectal, pancreatic, prostate and melanoma cancers.
Genes Tested GENE ASSOCIATED CANCER(S) SYNDROME
APC Colorectal, pancreatic and other Familial Adenomatous Polyposis syndrome, Gardner syndrome, and Turcot syndrome
ATM Breast, pancreatic Ataxia-telangiectasia (if both copies of the gene are mutated)
BAP1 Renal, melanoma, mesothelioma Familial Melanoma Cancer Syndrome
BARD1 Breast, ovarian
BMPR1A Colorectal, gastric, pancreatic Juvenile Polyposis syndrome
BRCA1 Breast, ovarian, pancreatic, prostate, male breast Hereditary Breast and Ovarian Cancer syndrome
BRCA2 Breast, ovarian, pancreatic, prostate, male breast, melanoma Hereditary Breast and Ovarian Cancer syndrome;
Fanconi anemia (if both copies of the gene are mutated)
BRIP1 Ovarian, breast Fanconi anemia (if both copies of the gene are mutated)
CDH1 Breast, gastric, colorectal Hereditary Diffuse Gastric Cancer
CDK4 Melanoma, pancreatic Familial Melanoma Cancer Syndrome
CDKN2A Melanoma, pancreatic Familial Melanoma Cancer Syndrome
CHEK2 Breast, colorectal
DICER1 Lung, kidney, thyroid, ovarian
EPCAM Colorectal, gastric, endometrial, ovarian Lynch (Hereditary non-polyposis colon cancer) syndrome
FANCC Breast Fanconi anemia (if both copies of the gene are mutated)
MRE11A Breast, ovarian Ataxia-telangiectasia-like Syndrome (if both copies of the gene are mutated)
MSH2 Colorectal, gastric, endometrial, ovarian Lynch (Hereditary non-polyposis colon cancer) syndrome
MSH6 Colorectal, endometrial Lynch (Hereditary non-polyposis colon cancer) syndrome
MUTYH Colorectal MUTYH-associated Polyposis syndrome
NBN Breast, melanoma, prostate Nijmegen breakage syndrome (if both copies of the gene are mutated)
PALB2 Breast, ovarian, pancreatic, male breast Fanconi anemia (if both copies of the gene are mutated)
PMS2 Colorectal, endometrial, gastric, ovarian Lynch (Hereditary non-polyposis colon cancer) syndrome
POLD1 Colorectal, endometrial Familial Adenomatous Polyposis syndrome
POLE Colorectal, gastrointestinal Familial Adenomatous Polyposis syndrome
PTEN Breast, uterine, colorectal, thyroid, kidney, melanoma Cowden Syndrome / PTEN Hamartoma Tumor Syndrome
RAD50 Ovarian
RAD51C Breast, ovarian Fanconi anemia (if both copies of the gene are mutated)
RAD51D Breast, ovarian
SDHA Gastrointestinal, other Paragangliomas 5
SDHB Gastrointestinal, renal, other Paraganglioma and gastric stromal sarcoma
SDHC Gastrointestinal, renal, other Paraganglioma and gastric stromal sarcoma
SDHD Gastrointestinal, renal, other Cowden Syndrome 3; Paraganglioma and gastric stromal sarcoma
SMAD4 Colorectal, gastric Juvenile Polyposis syndrome
STK11 Colorectal, endometrial, gastric, ovarian, breast, pancreatic Peutz-Jeghers syndrome
TP53 Colorectal, breast, pancreatic, sarcomas, gastrointestinal, adrenocortical, leukemia Li-Fraumeni syndrome
Specimen Requirements Blood (two 4ml EDTA tubes, lavender top) or Extracted DNA (3ug in EB buffer) or Buccal Swab or Saliva (kits available upon request)
Turnaround Time (TAT) 2-3 weeks

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BreastDx Clear™

BreastDx Clear™
Test Code: 1250
Test Description BreastDx Clear is a multi-gene test that analyzes 16 breast cancer susceptibility genes. Although all women have some risk of developing breast and/or ovarian cancer at some point in their lives, having a mutation in one of the breast cancer susceptibility genes increases this risk. Men who have a mutation in one of the breast cancer susceptibility genes have an increased risk of breast, prostate, pancreatic, gastric and other cancer types.
Genes Tested GENE ASSOCIATED CANCER(S) SYNDROME
ATM Breast, pancreatic Ataxia-telangiectasia (if both copies of the gene are mutated)
BARD1 Breast, ovarian
BRCA1 Breast, ovarian, pancreatic, prostate, male breast Hereditary Breast and Ovarian Cancer syndrome
BRCA2 Breast, ovarian, pancreatic, prostate, male breast, melanoma Hereditary Breast and Ovarian Cancer syndrome;
Fanconi anemia (if both copies of the gene are mutated)
BRIP1 Ovarian, breast Fanconi anemia (if both copies of the gene are mutated)
CDH1 Breast, gastric, colorectal Hereditary Diffuse Gastric Cancer
CHEK2 Breast, colorectal
FANCC Breast Fanconi anemia (if both copies of the gene are mutated)
MRE11A Ovarian, breast Ataxia-telangiectasia-like Syndrome (if both copies of the gene are mutated)
NBN Breast, melanoma, prostate Nijmegen breakage syndrome (if both copies of the gene are mutated)
PALB2 Breast, ovarian, pancreatic, male breast Fanconi anemia (if both copies of the gene are mutated)
PTEN Breast, uterine, colorectal, thyroid, kidney Cowden Syndrome / PTEN Hamartoma Tumor Syndrome
RAD51C Breast, ovarian Fanconi anemia (if both copies of the gene are mutated)
RAD51D Breast, ovarian
STK11 Breast, ovarian, colorectal, gastric, pancreatic Peutz-Jeghers Syndrome
TP53 Breast, brain, sarcomas, gastrointestinal, adrenocortical, leukemia Li-Fraumeni Syndrome
Specimen Requirements Blood (two 4ml EDTA tubes, lavender top) or Extracted DNA (3ug in EB buffer) or Buccal Swab or Saliva (kits available upon request)
Turnaround Time (TAT) 2-3 weeks

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ColoDx Clear™

ColoDx Clear™
Test Code: 1251
Test Description Colorectal cancer is the fourth most common type of cancer diagnosed in the United States and the second leading cause of cancer-related deaths in the country.
ColoDx Clear is a multi-gene test focused on hereditary colon cancer syndromes. Pathogenic variants (mutations) in high-risk colorectal cancer genes are associated with several hereditary cancer syndromes and increase the risk of cancer in many organs.
Genes Tested GENE ASSOCIATED CANCER(S) SYNDROME
APC Colorectal, pancreatic and other Familial Adenomatous Polyposis syndrome, Gardner syndrome, and Turcot syndrome
BMPR1A Colorectal, gastric Juvenile Polyposis syndrome
EPCAM Colorectal, gastric, endometrial, ovarian Lynch (Hereditary non-polyposis colon cancer) syndrome
MLH1 Colorectal, gastric, endometrial, ovarian Lynch (Hereditary non-polyposis colon cancer) syndrome
MSH2 Colorectal, gastric, endometrial, ovarian Lynch (Hereditary non-polyposis colon cancer) syndrome
MSH6 Colorectal, endometrial Lynch (Hereditary non-polyposis colon cancer) syndrome
MUTYH Colorectal MUTYH-associated Polyposis syndrome
PMS2 Colorectal, endometrial, gastric, ovarian Lynch (Hereditary non-polyposis colon cancer) syndrome
POLD1 Colorectal, endometrial Familial Adenomatous Polyposis syndrome
POLE Colorectal, gastrointestinal Familial Adenomatous Polyposis syndrome
PTEN Colorectal, endometrial, breast, melanoma Cowden syndrome
SMAD4 Colorectal, gastric Juvenile Polyposis syndrome
STK11 Colorectal, endometrial, gastric, ovarian, breast, pancreatic Peutz-Jeghers syndrome
TP53 Colorectal, breast, pancreatic and other Li-Fraumeni syndrome
Specimen Requirements Blood (two 4ml EDTA tubes, lavender top) or Extracted DNA (3ug in EB buffer) or Buccal Swab or Saliva (kits available upon request)
Turnaround Time (TAT) 2-3 weeks

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ProstateDx Clear™

ProstateDx Clear™
Test Code: 1257
Test Description: The ProstateDx Clear™  Panel examines genes associated with an increased risk for prostate cancer.  This test includes both well-established prostate cancer susceptibility genes, as well as candidate genes with limited evidence of an association with prostate cancer.
Genes Tested: ATM, BRCA1, BRCA2, CHEK2, EPCAM, HOXB13, MLH1, MSH2, MSH6,
NBN, PALB2, PMS2, TP53
Specimen Requirements Blood (two 4ml EDTA tubes, lavender top) or Extracted DNA (3ug in EB buffer)
or Buccal Swab or Saliva (kits available upon request)
Turnaround Time (TAT) 2-3 weeks

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