Question 1

For samples that have been received by the lab, what should we do if the patient or the client mentioned that we have incorrect patient information on file?

Accepted Answer

Update the accession and notate the account with the change.

Answer

Advise them that they have to submit a new order.

Answer

Transfer to Technical CS to obtain demographic form.

Question 2

Why is the self-pay pricing differs from the patient's EOOP?

Accepted Answer

Self-pay is the base/fixed price for all the patients for specific testing. Estimated OOP is based on each patient's current benefits with their insurance.

Answer

Patients have an option to cancel the testing if TRF was marked for self-pay billing but for insurance billing, they always have to move forward with the testing.

Answer

It is what it is.

Question 3

Which is of the following is the correct subject line format when sending email to the onshore team?

Accepted Answer

Requisition ID 12345  | BI Team or Order ID 12345 | BI Team

Answer

Onshore Billing Team | Accession ID 12345

Answer

Requisition ID 12345 | Accession ID 12345 | BI Team

Answer

Xifin Accession ID 12345 | BI Team

Question 4

If the patient has a BCBS MA as primary insurance with Medicaid insurance as a secondary, what should we advise them if they're calling for their EOOP?

Accepted Answer

As long as they are active on the DOS with their Medicaid insurance, they will not be billed for any amount.

Answer

Both PA and BI are required for us to determine the patient's responsibility.

Answer

We have to send an email to the onshore BI team to check if the patient will qualify for the $0 EOOP.

Question 5

To whom should we verify the account if the patient is 18 years old or above and the caller is not from the insurance, doctor's office, from GeneDx (sales rep)?

Accepted Answer

Patient

Answer

Verifying the account is not necessary as long as we obtain verbal permission.

Answer

Once we obtain verbal permission from the patient, we can verify the account from the caller.

Question 6

When should we offer applicable/available payment options to the patient?

Accepted Answer

1. When the patient mentioned that they cannot afford the EOOP. 2. When the patient asks for it. 3.  When the patient is still undecided.

Answer

Only if the patient mentioned that they can't afford the EOOP.

Answer

Only when the patient asks for it.

Answer

Only when the patient is still undecided.

Question 7

What should be done if the patient needs to change payment type (i.e., self-pay instead of commercial
insurance)?

Accepted Answer

If there is already an accession and is still pending, we can update the payor info accordingly.  If the healthcare provider has not yet submitted the order or there is no sample yet, the patient will need to let the provider know about the change. Then the provider will need to update the draft Portal order or fill out the TRF to ensure the correct payment type is selected.

Answer

If there is already an accession and is still pending, we have to send an email to the onshore team for further assistance.

Answer

If there is already an accession and is still pending, we can no longer update the payor info. We have to cancel the accession and have the provider resubmit a new one.  If the healthcare provider has not yet submitted the order or there is no sample yet, the patient will need to let the provider know about the change. Then the provider will need to update the draft Portal order or fill out the TRF to ensure the correct payment type is selected.

Answer

No action is required.

Question 8

Once the test has been run and results returned, it is not possible to switch from insurance to
self-pay or self-pay to insurance.

Accepted Answer

This is correct however if the patient is adamant to have it switched, we can send an email to the onshore team to ask if it is still possible.

Answer

False. We can always change the payor info whenever the patient wants to.

Question 9

If a patient’s insurance changes, how does a provider update it for a pending BI?

Accepted Answer

1.  If the provider is waiting for the results of a pending BI to be returned and did not yet complete
the test order, they may log into the Portal, update the patient’s insurance in the DRAFT test
order, then click the Conduct BI button again; alternately, they can create a new test order and
click the Conduct BI button. 
2. If the order has already been submitted but the sample has not been sent in, the provider needs
to cancel the order and submit a new one, following the same process.
3. If the sample has already been shipped, the provider needs to call GeneDx Billing at 1-888-729-
1206, option 2 to update the patient’s health insurance information. This information can only
be updated once the sample has arrived at GeneDx. The patient will need to reach out to their
health insurance company directly, to ask about their estimated OOP amount. Patients shall be
financially responsible for the OOP amount solely determined by their health insurance
company based on the patient’s medical benefit plan.

Answer

1.  If the provider is waiting for the results of a pending BI to be returned and did not yet complete
the test order, they may log out from the Portal, update the patient’s insurance in the DRAFT test
order, then click the Conduct BI button again;  they cannot create a new test order and
click the Conduct BI button. 
2. If the order has already been submitted but the sample has not been sent in, the provider needs
to cancel the order and submit a new one, following the same process.
3. If the sample has already been shipped, the provider needs to call GeneDx Billing at 1-888-729-
1206, option 2 to update the patient’s health insurance information. This information can only
be updated once the sample has arrived at GeneDx. The patient will need to reach out to their
health insurance company directly, to ask about their estimated OOP amount. Patients shall be
financially responsible for the OOP amount solely determined by their health insurance
company based on the patient’s medical benefit plan.

Answer

1.  If the provider is waiting for the results of a pending BI to be returned and did not yet complete
the test order, they may log out from the Portal, update the patient’s insurance in the DRAFT test
order, then click the Conduct BI button again; alternately, they can create a new test order and
click the Conduct BI button. 
2. If the order has already been submitted but the sample has not been sent in, the provider needs
to cancel the order and submit a new one, following the same process.
3. If the sample has already been shipped, the provider needs to call GeneDx Billing at 1-888-729-
1206, option 2 to update the patient’s health insurance information. This information can only
be updated once the sample has arrived at GeneDx. The patient will need to reach out to their
health insurance company directly, to ask about their estimated OOP amount. Patients shall be
financially responsible for the OOP amount solely determined by their health insurance
company based on the patient’s medical benefit plan.

Question 10

What happens if a provider orders a test but forgets to perform a BI before the sample is sent to
GeneDx?

Accepted Answer

Once a sample is sent in and all necessary paperwork is received, the testing process will begin. The order may be canceled before the sample is tested; however, if the test is not canceled, the patient will
be responsible for the cost of testing. We encourage patients who have questions about their estimated
OOP to reach out to their insurance directly to ask about their medical benefits
coverage.

Answer

Once a sample is sent in and all necessary paperwork is received, the testing process will still not begin. The order may be canceled before the sample is tested; however, if the test is not canceled, the patient will not
be responsible for the cost of testing. We encourage patients who have questions about their estimated
OOP to reach out to their insurance directly to ask about their medical benefits
coverage.

Answer

Once a sample is sent in and all necessary paperwork is received, the testing process will still not begin. The order may be canceled before the sample is tested; however, if the test is not canceled, the patient will not
be responsible for the cost of testing. We encourage patients who have questions about their estimated
OOP to reach out to their ordering provider directly to ask about their medical benefits
coverage.

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