Insurance Billing

Using Commercial Insurance with GeneDx

Information provided on this page is intended only for U.S.-based patients.

GeneDx accepts all commercial insurance and we are in-network with the majority of commercial health plans. The patient is financially responsible for the member responsibility amounts their health insurance plan lists on the Explanation of Benefits (EOB), which may include co-pay, coinsurance, and unmet deductible.

Insurance Billing Process

Step 1: Healthcare Provider Orders a Test & Performs Benefit Investigation

While navigating the insurance process can be complicated, we’re here to help make it easier. The below steps will guide you through what’s needed during the ordering process and how to obtain the patient’s estimated financial responsibility by performing a benefit investigation (BI).

Placing your order

To help ensure a smooth testing process without unnecessary delays, visit the GeneDx Provider Portal to initiate an order and perform a BI. For billing purposes and to facilitate any necessary prior authorization, submit the following information, if available, along with an order:

  • ICD 10 diagnosis code(s) to the highest level of specificity
  • Prior authorization reference number if already initiated, or, if approved, the insurance letter of prior authorization approval
  • Clinical documents, including the summary from genetic counseling appointment
  • Summary of patient’s clinical diagnosis/presentation
  • Pedigree or summary of three-generation maternal and paternal family history

Go paperless! You can submit all information quickly along with the order in the GeneDx Provider Portal. Otherwise, the information can be sent with your patient’s sample(s) or directly to our Missing Info Team (fax: 1-201-421-2304, GDXRCMissinginfo@genedx.com).

PORTAL INFO GUIDES

New instant BIs!

We’re making it faster and easier for you to conduct a BI. Our new BI process is completed within the GeneDx Provider Portal, and in most cases, you’ll get an immediate result. For the rest, the BI will be returned to the portal, usually within 3-5 business days.

Patients should be reminded that any BI is an estimate only of the out of pocket amounts that patients may owe for their laboratory services. Patients should contact their insurance companies or health plans directly for confirmation of their out of pocket obligations.

As part of the BI process, a personalized Patient Letter is available for you to download and share with your patient. It includes their out-of-pocket estimate, self-pay pricing, and payment assistance information to aid their testing decision.

Once an order is submitted and a sample arrives at the lab, we will proceed with the testing and bill according to the test requisition. Your patient will be financially responsible for any out-of-pocket amount as determined by their health insurance provider.

BI INFO GUIDES

If patients have questions on their fees or self-pay options, they can contact billing@genedx.com or call 1-888-729-1206, option 2.

Step 2: Prior Authorization (PA)

If a patient’s health insurance plan requires prior authorization (PA) or medical pre-certification, the test will be put on hold until an approved PA is obtained.

Questions? We can help!
If assistance is needed with prior authorization, contact our Prior Authorization Team at GeneDxPriorAuth@genedx.com

Missing info?

  • If any information necessary to submit the prior authorization is missing, our Missing Info Team will reach out to you to request the documents.
  • To expedite, send information directly to our Missing Info Team – Fax: 1-201-421-2304, GDXRCMissinginfo@genedx.com

The GeneDx Prior Authorization Team will reach out to the patient/guardian to inform them of the PA process. Please note that an approved PA does not guarantee insurance coverage and does not change the estimated BI amount.

Step 3: GeneDx Mails Bill to Patient

Once testing has been performed and a claim submitted to the patient’s health insurance company, the patient’s health insurance company will send an Explanation of Benefits (EOB) letter. We will send a bill, and a claim submitted to the patient’s health insurance company, to the patient for the member financial responsibility amount indicated on the EOB.


 
 

Tip: Patients do not need to make any payment until they receive a bill from GeneDx.

Patients who are eligible, apply for, and are approved for the Financial Assistance Program will receive a second bill with the adjusted amount.

Insurance Billing Forms

Plans may require additional documentation to complete the prior authorization and/or billing process. Additional forms can be accessed here.

Commercial Insurance Contracts

GeneDx is a United Healthcare (UHC) Preferred Laboratory.

National Plans

  • United Healthcare (UHC)
  • Aetna
  • Cigna

Blues Plans

  • Empire BCBS
  • Empire BCBS HealthPlus
  • Anthem BCBS GA
  • Anthem BCBS VA
  • Anthem BCBS IN
  • Anthem BCBS KY
  • Anthem BCBS OH
  • Anthem BCBS MO
  • Anthem BCBS WI
  • Anthem BCBS CT
  • Anthem BCBS ME
  • Anthem BCBS NH
  • Anthem BlueCross CA
  • BCBS South Carolina (administered by Avalon)
  • BCBS Alabama
  • BCBS Arizona
  • BCBS of Illinois
  • BCBS of Kansas
  • BCBS Massachusetts
  • BCBS Michigan (Commercial Only)
  • BCBS Nebraska
  • BCBS North Dakota
  • BCBS North Carolina (Medicare Advantage)
  • BCBS of Rhode Island
  • BCBS of Texas
  • BCBS of Vermont
  • BCBS of Western NY (Healthnow)
  • Blueshield of Northeastern NY (Healthnow)
  • BlueShield of California
  • Capital Health Plan
  • CareFirst Blue Cross & Blue Shield
  • Wellmark BCBS (Iowa & South Dakota)

Other Plans

  • Aetna Better Health NJ
  • Aetna Better Health VA
  • Aetna Better Health WV
  • Affinity Health Plan, Inc
  • Alameda Alliance for Health
  • American CareSource Holdings (dba Ancillary Care Solutions)
  • Amerigroup DC
  • Amerigroup FL
  • Amerigroup Georgia
  • Amerigroup Iowa
  • Amerigroup Kansas fka KanCare
  • Amerigroup Louisiana fka Healthy Blue
  • Amerigroup Maryland
  • Amerigroup Nevada
  • Amerigroup New Jersey
  • Amerigroup New Mexico
  • Amerigroup Texas
  • Avera Health Plans
  • Amerigroup Tennessee
  • Amerigroup Washington
  • AmeriHealth Caritas Delaware Multiplan
  • CalOptima
  • CareSource West Virginia
  • CareSource Kentucky
  • Centene Corp
  • Bridgeway Health Solutions
  • Cenpatico Integrated Care
  • Ambetter
  • California Health & Wellness
  • Sunshine Health
  • Peach state Health plan
  • Illinicare health
  • Managed Health Services (MHS)
  • Sunflower Health Plan
  • Louisiana Healthcare Solutions
  • Michigan Complete health
  • Magnolia Health
  • Home State Health
  • NH Health Families
  • Buckeye Health Plan
  • Trillium
  • Absolute Total Care
  • Superior Healthplan
  • Coordinated Care
  • MHS Health Wisconsin
  • Commonwealth Care Alliance, inc
  • Community Care Plan CCP – fkna SFL Community Care Network
  • Community First Health Plan
  • Common Ground Healthcare Cooperative
  • Community Care Alliance of Illinois (CCAI)
  • Community Health Choice
  • Cook Childrens Health Plan
  • Coventry WV
  • Crystal Run HP
  • Dean Health Plan
  • Employer Health Alliance
  • Evicore Healthcare (EVC)
  • Evolutions Healthcare Systems, Inc NAT PPO NETWORK
  • First Carolina Care
  • First Choice HP of Mississippi PPO Network
  • Geisinger Health Plan
  • Group Health Cooperative
  • Gulf Coast Provider Network – Sarasota Memorial PHO
  • Hawaii Medical Services Assoc. (BCBS Hawaii)
  • Health Alliance Medical Plans
  • Health Net Fed Services – TRICARE NORTH & WEST
  • Health Net of California, Inc
  • Health New England
  • HealthCare Partners
  • HealthFirst
  • HealthNet, Inc. Health Choice of Alabama PPO Network
  • HealthNow NY, Inc
  • HealthPartners, Inc.
  • HealthSmart
  • Humana Military – TRICARE SOUTH
  • Independent Medical Systems
  • Indiana University Health Plan (IUHP) & MDWise
  • Inland Empire Health Plan
  • Island Group Administration, Inc
  • Jade Medical Group
  • JVHL (Joint Venture Hospital Laboratories)
  • Lehigh Valley Health Network
  • Loyola University Medical Center
  • Maryland Physicians Care
  • Medical Cost Containment
  • Memorial Health Partners Hospital Network
  • Meritage Medical Network
  • Mississippi Physician’s Care Network
  • Molina of South Carolina
  • Molina HC of Utah
  • Molina HC of Washington, Inc
  • MultiPlan, Inc
  • NAMCI
  • Neighborhood HP of Rhode Island
  • NovaNet, Inc.
  • Partners Health Plan
  • Ped-I-Care (CMS CSHCN)
  • Physicians Plus
  • Pomco
  • Preferred One
  • Prime Health Services PPO Network
  • Provider Select
  • River City Medical Group
  • Rocky Mountain Health Plan
  • Samaritan Health Services
  • Sanford Health Plan
  • Scott & White Health Plan
  • Sharp Rees-Stealy Medical Group, Inc
  • South Broward Hospital District – Memorial Integrated Health Network MHNS
  • Stratose
  • Suburban Health Organization
  • Sutter East Bay Hospitals
  • Sutter East Bay Medical Foundation
  • Sutter Physicians Alliance
  • Three Rivers Provider Network
  • Tufts Associated HMO, Inc.
  • University of Maryland Health Plans
  • University of Maryland Health Partners
  • University of Maryland Health Advantage
  • US Family Care
  • Virginia Health Network
  • Viva Health Medicare Advantage
  • Viva Health Commercial HMO
  • WellCare Health Arizona
  • WellCare Health Arkansas
  • WellCare Health Connecticut
  • WellCare Health Georgia
  • WellCare Health Illinois
  • WellCare Health Kentucky
  • WellCare Health Louisiana
  • WellCare Health Maine
  • WellCare Health Mississippi
  • WellCare Health Missouri
  • WellCare Health New Jersey
  • WellCare Health New York
  • WellCare Health South Carolina
  • WellCare Health Tennessee
  • WellCare Health Texas
  • Wellmark BCBS Iowa
  • Wellmark BCBS South Dakota
  • Zelis HealthCare

Medicare

GeneDx is a Medicare provider and therefore is able to accept Medicare patient samples, if covered by Medicare coverage policy. A completed Advance Beneficiary Notice (ABN) is required when Medicare medical necessity criteria are not met.

Medicaid

While GeneDx is a registered provider with several Medicaid plans, prior authorization (PA) is required for Medicaid samples. GeneDx will initiate these PAs.

There are some Managed Medicaid plans which stipulate that prior authorizations must be obtained by the ordering physician’s office.

For all Medicaid samples, tests will be placed on hold and will not proceed in the lab until an approved PA is obtained. In some cases, Medicaid will not cover genetic testing for these conditions, as Medicaid coverage varies by state.

States where GeneDx is a Medicaid Registered Provider
  • Alabama Medicaid
  • Alaska Medicaid
  • Arizona Medicaid
  • Arkansa Medicaid
  • California Medicaid
  • Colorado Medicaid
  • Connecticut Medicaid
  • Florida Medicaid
  • Georgia Medicaid
  • Illinois Medicaid
  • Indiana Medicaid
  • Idaho Medicaid
  • Iowa Medicaid
  • Kansas Medicaid
  • Kentucky Medicaid
  • Louisiana Medicaid
  • Maine Medicaid
  • Maryland Medicaid
  • Massachusetts Medicaid
  • Michigan Medicaid
  • Minnesota Medicaid
  • Mississippi Medicaid
  • Missouri Medicaid
  • Montana Medicaid
  • Nebraska Medicaid
  • New Jersey Medicaid
  • New Mexico Medicaid
  • New York Medicaid
  • North Carolina Medicaid
  • North Dakota Medicaid
  • Ohio Medicaid
  • Oklahoma Medicaid
  • Oregon Medicaid
  • Pennsylvania Medicaid
  • South Carolina Medicaid
  • Tennessee Medicaid
  • Texas Medicaid
  • Utah Medicaid
  • Vermont Medicaid
  • Virginia Medicaid
  • Washington (State) Medicaid
  • Washington DC Medicaid
  • West Virginia Medicaid
  • Wisconsin Medicaid

Ways to Pay & Installment Plans

GeneDx allows multiple ways for patients to pay their bill and offers no-interest, no-fee payment plans. Learn more

GeneDx offers a Financial Assistance Program, which may cover all or part of the patient’s responsibility for certain financial circumstances. Learn more

Patients: If you receive a payment from your health insurance company, it is your responsibility to pay GeneDx within 10 days of receipt of that payment.

PAY MY BILL