Our dedicated team of billing experts is available to answer patients’ questions so you can focus on providing the best care.
GeneDx accepts all commercial insurance, Medicare, Medicaid, and Tricare and encourages prior authorization (PA) for all test orders. We offer self-pay pricing and a Financial Assistance Program (FAP) for eligible patients. In addition, we can bill your institution directly.
We are in-network with many national and regional health plans. For a complete list of in-network plans, please refer to our In-Network Contract List.
We encourage you to submit a prior authorization and supporting documentation, such as a clinic note, up front with each test order. This information can also help us uncover more actionable answers for your patients.
The following information should be submitted at the time of order placement:
Some health insurers may require:
The above list is not exhaustive, and some items do not apply as payor criteria vary. Some commercial health insurance plans may require additional documentation to complete the prior authorization and/or billing process. You can access those forms here.
Please note: Missing information could result in delayed or canceled testing. We may contact you if additional information is needed.
GeneDx accepts all Medicaid with prior authorization (PA). We can submit the PA on the providers’ behalf with Medicaid and/or a Managed Care Organization (MCO) if, at the time of order placement, providers include:
GeneDx is an approved Medicare provider and accepts Medicare as a form of insurance, including Medicare Advantage plans.
Institutional billing allows GeneDx to bill your institution directly and is intended to simplify the test ordering process for healthcare providers. To establish an institutional account with GeneDx, please reach out to GeneDx Accounts at (888)729-1206, option 4.
Self-pay pricing varies based on the test ordered. If a patient is interested in self-pay, please select the Patient Bill option when ordering the test(s) in the GeneDx Provider Portal or on the test requisition form.
At GeneDx, we firmly believe that everyone deserves access to vital insights from genetic testing, regardless of their financial situation which is why we offer a robust Financial Assistance Program to help reduce the potential out-of-pocket costs associated with testing.
The program has broad eligibility criteria; over 90% of patients could qualify for reduced financial responsibility.
Please send the form below to your patient and have them return the completed, signed application to billing@genedx.com. If the application is approved, this may reduce the amount owed on their final bill.
We support providers through the prior authorization (PA) process and have partnered with a third-party partner to obtain PAs on your behalf. Our partner works directly with payors to obtain PAs and submits the approval/denial information to GeneDx on behalf of providers. Learn more here.
To help patients understand what they may expect to pay out-of-pocket, we offer a benefits investigation. This provides an estimate only, and the patient’s insurance determines the final bill.
It’s also important to note that approval or denial of a PA can impact a patient’s final bill, regardless of what estimate a benefits investigation may provide.
We have a dedicated billing team that can help answer your patients’ questions so you can focus on what matters most.
GeneDx’s Patient Billing Team can be reached via email at billing@genedx.com. Email allows our team to provide more detailed answers to questions, but if patients are unable to contact us via email, they can call us at (888) 729-1206, dial option 2, repeat 2.
For more details, please visit our Patient Billing page.
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