1You order an Oncotype or OncoExTra test
Ordering a Test
Ordering a test and receiving the results is a straightforward process.
For faster results, complete your requisition form online on the Provider Portal
Be sure to include a copy of your patient’s insurance card and the primary ICD-10 code selection supporting medical necessity. When ordering for your Medicare patients, please include the Specimen Collection Date and Patient Hospital Status to streamline the process.
2We verify and bill insurance
Verify & Bill Insurance
The billing process starts with performing insurance verification for each patient using the insurance information provided when the test is ordered.
We obtain prior authorizations, when required by the payer, using the documentation provided by your office on the completed requisition form. The insurance information you provide helps us determine whether prior authorization or other forms are required by the insurance company. We will contact your office with instructions if the payer requires that the physician initiate the Prior Authorization or asks for additional documentation from your office.
Explanation of Benefits
Once testing is complete, we handle insurance billing on behalf of your patients when this option is selected on the requisition form. Patients may receive one or more Explanation of Benefits (EOB) from their insurance company. Even though this is not a bill, we are here to answer any questions patients may have.
3We offer financial assistance
Assistance with Appeals
If the claim is denied, we will pursue appeals on the patient’s behalf if appeal options are available. This process can take several months.
Out-of-Pocket Payment Options
Out-of-pocket (OOP) costs for the test, if any, are determined by the insurance company. Patients may have financial responsibility for a co-pay, co-insurance, deductible or non-covered charges as determined by their insurance plan once available appeal options are completed. If your patient’s out-of-pocket amount exceeds $500, they will receive a call to discuss payment options. We will also submit secondary or supplemental insurance claims on your patient’s behalf if the necessary information was submitted with the order. If your patient receives a bill and is not sure if a claim was submitted to their secondary or supplemental insurance, please have your patient contact us.
Financial assistance is available for eligible patients who are uninsured and may be available for insured patients unable to pay the out-of-pocket amount determined by their insurance.
- Eligibility is based on Federal poverty guidelines, and we proactively contact all uninsured patients to determine eligibility for financial assistance. Payment plans may also be available.
- Patients may also contact us before the test is ordered or during the testing process to review available payment terms or to be pre-screened† for financial assistance.
- Financial assistance is not available if a patient has insurance coverage but elects to be billed directly instead of billing insurance.
Oncotype and OncoExTra tests are covered by Medicare Fee for Service (FFS) for patients meeting coverage criteria. Patients who meet clinical criteria for coverage have zero financial responsibility.
Advance Beneficiary Notice (ABN) Requirements
Medicare FFS requires that providers give their Medicare patients an ABN form before they receive any services not considered medically necessary under the Medicare FFS program. This is required because the patient will be responsible for paying for the test if they still choose to receive it.
The 14-Day Rule
Medicare FFS has specific date of service reporting requirements for laboratory tests, and the technical component of physician pathology services, ordered for Medicare patients (commonly known as the “14-Day Rule”). The 14-Day Rule determines whether the laboratory performing the test bills Medicare directly or bills the hospital where the specimen was collected.
In general, Medicare requires that laboratories bill the hospital when the test is ordered less than 14 days following a patient’s inpatient or outpatient hospital stay (when the specimen was collected). However, as of January 1, 2018, the 14-day rule does not apply to molecular pathology tests when the specimen is collected from a hospital outpatient, regardless of order date.
We process test orders as they are received from providers. Clinical judgment should be the determining factor for test ordering.
Have a specific billing question?
Contact us to learn more about billing and coverage for our tests.