Monday, May 27 is Memorial Day. Our lab and all support services will be closed. Kit orders placed on May 27 will be sent on May 28, and all in-transit patient samples will be held by the carrier and received on May 28. If you need assistance, please leave a message at (888) 729-1206 or support@genedx.com and we will respond when we return on May 28.

Provider Billing

GeneDx’s dedicated billing team is committed to making the process quick and easy. 

Our dedicated team of billing experts is available to answer patients’ questions so you can focus on providing the best care.

Billing Options

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.


Commercial Insurance

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.

How to Help Ensure a Smooth Billing Process with Commercial Insurance

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:

  • Clinic note including the following information:
  • Patient medical records supporting the need for testing
  • Description of how testing may impact the patient’s clinical management
  • Documentation of patient counseling, including review of family history (by genetics professional when required)
  • Copy of the patient’s primary insurance card (front and back)

Some health insurers may require:

  • Prior authorization approval documentation
  • Health insurance-specific forms
  • History of prior genetic testing
  • Copy of patient’s secondary insurance card (front and back)

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.


Medicaid

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:

  • Clinical notes
  • Historical medical records supporting the need for testing and show previous tests ordered
  • Documentation of genetic counseling (where applicable)
  • Any payer-required PA form

Medicare

GeneDx is an approved Medicare provider and accepts Medicare as a form of insurance, including Medicare Advantage plans.  


Institutional Billing

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

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.   


Financial Assistance Program

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. 


Prior Authorization Support

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.  


Benefits Investigation (BI)

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.

Billing Support

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.