Payment Options

• Insurance
• Patient Prepay
• Clinician Billing
• Medicare

Please Note: Effective October 15, 2012, BCBS of Georgia will begin following its Association Ancillary Billing Guidelines as mandated by the Blue Cross and Blue Shield (BCBS) Association of all BCBS licensees nationally. The change will affect patients whose healthcare providers (HCP) practice outside the State of Georgia. This means that Metametrix will accept assignment of BCBS claims for Georgia and Federal Employee (FEP) BCBS subscribers ONLY. For more information, please contact us.

Insurance

Metametrix Insurance Billing programs allow patients to enjoy the benefits customarily associated with traditional insurance-reimbursed medical services. We now offer four Insurance Billing options to make the payment process simple, based on insurance type and testing ordered. The details of each program are outlined below:

• Bill Insurance (contracted providers)
• PrePay Advantage (prepayment with courtesy insurance claim filed)
• EasyPay (GI Effects and ION Profiles ONLY)
• Medicare/Medicare Advantage

Please contact us for more information. Please note: Missing information can result in the delay of test results.

1. Bill Insurance: Metametrix Contracted Insurance

Metametrix is contracted (an in-network provider) with a growing list of insurers, and bills to contracted insurance carriers on the patient’s behalf if insurance billing is indicated on the requisition.Please note: Patients with contracted insurance should utilize the EasyPay insurance billing program w eligible profiles (GI Effects and ION Profiles)

• If the patient’s insurance company is contracted with Metametrix the patient should provide insurance information, with patient and responsible party details, diagnosis code(s), and a copy of the front and back of their insurance card.
• If the patient  is submitting and EasyPay requisition for and EasyPay Eligible Profile  the patient should submit a payment method for the EasyPay Amount. Collection of the EasyPay amount up to the patient responsibility will occur after insurance processing, if applicable
• If the profile is not an EasyPay eligible test,  Metametrix will submit a claim on the patients behalf and the patient will be billed for their portion once the claim is adjudicated.  Metametrix) must receive the diagnosis ICD-9 code(s) and valid NPI number from the referring health care practitioner on the requisition. A listing of codes can be found at ICD-9 codes
• Patients are billed per the Explanation of Benefits and the EasyPay insurance program guidelines, if applicable.
• If you are utilizing the EasyPay program for a eligible profile, please see below for information on how  to utilize the program and program  rules and guidelines.

Contracted Insurance Companies (as of 02/06/13):

For more information, click on the featured links below.

• Highmark Blue Cross Blue Shield (for patients receiving services from practitioners in Pennsylvania and West Virginia) This includes the following programs:
  • Highmark Blue Shield
  • Keystone Health Plan WEST - Medicare Advantage
  • Freedom Blue - Medicare Advantage
  • Secure Blue HMO - Medicare Advantage
  • BCBS of Northeastern Pennsylvania
  • Pennsylvania Independence Blue Cross
  • All Pennsylvania & West Virginia Blue Card Claims (any BCBS member with a BCBS Plan from any other state)

  PA Blue Cross and Blue Shield plans NOT included in the Highmark contract and are therefore non-contracted/out of network:

  • First Priority Health
  • First Priority Life
  • Keystone Health Plan EAST
  • Personal Choice
  • Independence Administrators
  • Capital BlueCross of Pennsylvania

• CareFirst Blue Cross Blue Shield
  • Blue Cross and Blue Shield members, including Federal Employee Program, receiving services ordered by HCPs that reside in MD, DC and Northern VA.
  • Excludes Carefirst BCBS HMO products identified with prefixes XIC, XIK, XWR, XIR. These plans are considered non-contracted/out-of-network.
• Blue Cross Blue Shield of Kansas City for Blue Cross and Blue Shield patients receiving services in the Blue Cross and Blue Shield of Kansas City service area in Missouri and Kansas
• Blue Cross Blue Shield of Georgia for Metametrix branded testing for BCBS patients receiving services from practitioners in GA.
• Blue Cross Blue Shield Federal Employee Program (FEP), limited to:
  • Federal Blue Cross and Blue Shield members receiving services ordered by Health Care Practitioers in the Carefirst Blue Cross and Blue Shield service area (MD, DC and Northern VA) for all Genova Diagnostics and Metametrix testing.
  • Metametrix Branded profiles such as the GI Effects and ION products for all states.
• Blue Shield of California for BCBS patients receiving services from practitioners in CA, including out of state BCBS patients.
  • Excluded: Anthem Blue Cross of CA members are non-participating but are eligible for the EasyPay Program.

2. Bill Insurance: PrePay Advantage

For patients not having an EasyPay Eligible profile or who do not have contracted insurance, Metametrix will submit an insurance claim on the patient’s behalf under the PrePay Advantage program.  .

• Patients must include the PrePay Advantage payment (payment of the pre-pay price), insurance information, front and back copy of insurance card.
• Metrametrix must receive the diagnosis code(s) and valid NPI number from the referring health care practitioner on the Requisition.
• A claim will be submitted to the patient's insurance company directing payment to them.
• Failure to include all necessary information may result in exclusion from the program and patients will be responsible for filing the claim to insurance.
• The special Patient Prepay price is due, in full, at the time of specimen submission. Missing information and/or payment will delay test results.
• Filing this courtesy claim does not guarantee reimbursement from the insurance provider.
• If the claim is denied, the patient will be notified by Metametrix and an Explanation of Benefits (EOB) will be provided by his/her insurance provider. It will be the patient’s responsibility to deal directly with the insurance carrier regarding any errors, omissions, or appeals.

For more information on this value-added service, please contact Client Services at 800.221.4640.
Please note that not all insurance plans are applicable for PrePay Advantage.
Missing information can result in the delay of test results.

3. Bill Insurance: EasyPay Program (GI Effects and ION Profiles ONLY)

Patients should choose our EasyPay insurance billing program if they are having an EasyPay Eligible test and their insurance plan qualifies for the EasyPay insurance program. Please click here for more information on using the EasyPay program  for EasyPay Eligible tests..- Patients should follow the EasyPay Guidelines to avoid being billed up to list price for our services.

• Patients must include a payment method for the EasyPay amount and the proper EasyPay requisition to qualify for the program. Non-contracted insurance: collection of the EasyPay amount occurs prior to submission to insurance. Contracted insurance and Medicare Advantage: collection of the EasyPay amount occurs after insurance processing, if applicable.
• After an insurance claim has been received outlining benefits, the EasyPay amount will be applied to the patient responsibility per the Explanation of Benefits (EOB) provided by the insurance carrier. If applicable, a statement will be generated to the patient for outstanding deductibles, co-insurance, or co-pays, assigned over the EasyPay amount.
• Most insurance companies provide payment and an EOB directly to Metametrix/Genova Diagnostics. However some insurers, such as Blue Cross & Blue Shield, pay patients directly. If the patient is paid directly, they are required to forward the insurance payment and a copy of the EOB to Metametrix/Genova Diagnostics. If Metametix/Genova Diagnostics is unable to directly determine the application of benefits through the patient’s insurance, the patient is required to provide a copy of the EOB to Metametrix/Genova Diagnostics.
• If the insurance carrier will not accept or adjudicate the claim filed by Genova Diagnostics, the patient may be asked to file a claim directly to their insurance carrier.
• For more information on the EasyPay guidelines, please consult the flyer inserted in the test kit, or contact us at info@gdx.net, or by phone at 800-522-4762, extension 1, or Click here.

How to Use Genova Diagnostics EasyPy Insurance Billing Program
Following these 3 steps below will ensure that patients using the EasyPay program enjoy lower out-of-pocket expense.

• Step 1 - Payment: The EasyPay program requires a payment method for the EasyPay amount.
• Step 2 - Practitioner Information: Provision of practitioner-specific information is necessary for the filing of a health insurance claim on the patient’s behalf:
  • Complete the requisition with ICD-9 diagnosis coding noted
  • Practitioner must have a valid NPI, which must be entered on the requisition
• Step 3 - Insurance Information: Patient must provide insurance information with a copy of the front and back of the patient's insurance card.
  • The patient must be a current subscriber in an accepted health insurance program. Please see the billing options listed above or call Client Services at 800-522-4762, ext 1, if you are uncertain under which option the patient will qualify.
  • With the EasyPay program, if payment from insurance goes directly to the patient, the patient must forward that payment amount, along with a copy of the Explanation of Benefits (EOB), to Genova Diagnostics. This occurs most often with Blue Cross and Blue Shield subscribers.
  • In order to substantiate medical necessity for testing and to qualify for insurance reimbursement, practitioners may be required to provide medical records to the patient’s insurance carrier. Practitioner failure to provide this information to the insurance carrier in a timely manner may result in patients being billed for the full patient responsibility, up to the list price of the test. If medical records are requested for patients adhering to thee Prepay Advantage program, the patient will be responsible for obtaining that information and filing it directly with the insurance company.

Please note that each of the items shown in Steps 1-3 are required for the patient to be included in these programs. If any of the items above are not provided for patients utilizing the EasyPay program, patients will be responsible for the full patient responsibility, up to the list price of the test, minus payments received by Genova Diagnostics/ Metametrix Clinical Laboratory.

For more information on the EasyPay guidelines, please consult the flyer inserted in the test kit, or contact us at info@gdx.net, or by phone at 800-522-4762, extension 1, or Click here

4. Medicare/Medicare Advantage

Currently, we are under contract as an in-network provider for patients with Medicare and Medicare Advantage coverage. For these patients, NO PAYMENT IS DUE with specimen submission.

Please note: Test profiles that are considered diagnostic or necessary to aid physicians in diagnosing conditions are listed below. Important information on All Other Tests is also listed below.

(Diagnostic) Test Profiles Potentially Eligible for Coverage:

GI Effects (The GI Effects Profile is used to identify gastrointestinal disorders)

• 2100 GI Effects Complete Profile – Stool
• 2105 GI Effects Microbial Ecology Profile – Stool
• 2110 GI Effects Mycology Profile – Stool
• 2115 GI Effects Parasitology Profile – Stool
• 2120 GI Effects Chemistries Profile – Stool

Coverage eligibility for remaining test profiles will be at the discretion of Medicare. However, Medicare is NOT expected to cover tests that do not appear on the Potentially Eligible list (shown above).

Things to Consider

• For tests other than our GI Effects Profiles, Patient Prepay may be a feasible option for Medicare patients. Medicare Advantage patients may want to select Prepay Advantage.
• If you submit your Medicare information to have Metametrix file a Medicare claim for tests that do not appear on the Potentially Eligible list you may be billed up to list price if Medicare denies the claim (which is most likely). When selecting the Medicare option under this circumstance, the patient will no longer be eligible to receive the prepay price.
• Medicare patients should submit a completed Advanced Beneficiary Notice (ABN) of Non-Coverage for tests not listed on the potentially eligible list.
• Please select option 1 if you would like us to submit a claim to Medicare. If the claim is denied you will be billed up to the list price of the test.
• Please select option 2 if you would like to prepay for the test at the discounted prepayment price, a claim will not be submitted to Medicare.
  • If choosing to have Metametrix submit a claim on your behalf you must provide your Medicare/Medicare Advantage information.
  • If Medicare denies the patient’s claim, the patient or responsible party will be notified, will receive an Explanation of Benefits (EOB), and will be billed for the outstanding balance.

Missing information can result in the delay of test results.

Patient Prepay

Using this option, an insurance claim WILL NOT be filed AND payment of the special prepay price is due, in full, with specimen submission and a signed, completed Test Requisition Form (TRF). If out-of-network insurance information is provided, a complimentary filing will be done by Metametrix under the PrePay Advantage program.

Acceptable forms of payment are:

• Visa/MC/AMEX/Discover
• Money Orders
• Checks made payable to Metametrix, Inc. (Only checks drawn from a U.S. bank are accepted)

Please note:

• We do not bill patients who choose to utilize the Patient Prepay option. Payment is due, in full, with specimen submission.
• We do not file insurance claims for Worker's Compensation.

Missing information can result in the delay of test results.

Using this option, a patient pays his/her clinician directly for testing services. Accordingly, the clinician becomes responsible for payment and will be billed by Metametrix. Please contact your physician directly to discuss this option.

*Exceptions - New York (NY), New Jersey (NJ), and Rhode Island (RI): Clinicians in NY, NJ, and RI are prohibited (by the laws of each respective state) to bill patients for laboratory services,  and as such Metametix is probiited from billing directly to practitioners in these statesPatients in these states are encouraged to select our one of our Insurance billing options or Patient Prepay option.

Missing information can result in the delay of test results.

National Provider Identifier (NPI)

A NPI is required, per HIPAA mandate, for all insurance claims to be filed. The NPI is a unique identification number for covered health care providers. The NPI must refer back to the ordering clinician in order to be valid. Also, per HIPAA mandate, covered providers must share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. Please verify that the ordering clinician has a National Provider Identifier prior to utilizing insurance options.

Price Quoting

Metametrix does not disclose pricing per our agreement with Metametrix clinicians. Please consult with your physician on any questions regarding pricing.

Missing Information

If required information and payment are not received, test results may be delayed. Please review the table below to be sure that you are providing everything necessary to process the billing/payment option that you have selected.

*Metametrix will bill the patient (or responsible party) for any outstanding balance not covered by Medicare or insurance.

**An ABN is required for tests that Medicare classifies as being used for screening purposes (as opposed to being used to identify a specific diagnosis). For Metametrix branded tests, all test profiles require an ABN with the exception of GI Effects Profiles.