Billing Frequently Asked Questions
What is your tax identification number?
PreventionGenetics LLC Tax Identification Number is 83 0343803.
Does PreventionGenetics accept insurance?
PreventionGenetics will file an insurance claim on behalf of the patient with any commercial insurance company.
What is necessary for PreventionGenetics to bill insurance?
Page 3 of the TRF indicates the information needed for insurance billing. This section must be completed in its entirety before testing can begin. This includes additional information such as benefit investigation information, pertinent medical record information, and/or a letter of medical necessity.
Do you have any tools to help families/patients navigate the preauthorization process?
Yes, we work with PLUGS, a non-profit laboratory stewardship collaboration within Seattle Children’s Hospital. This group provides guidance, tools and education to help labs reduce laboratory testing expenses. They developed this guide to help educate patients and families on how to help get complex lab tests authorized by insurance.
Do you have any tools to help caregivers navigate the preauthorization process?
Yes, we work with PLUGS, a non-profit laboratory stewardship collaboration within Seattle Children’s Hospital. This group provides guidance, tools and education to help labs reduce laboratory testing expenses. They have developed several resources to help caregivers navigate the preauthorization process.
If insurance has been verified and preauthorization obtained, why would my patient receive an invoice for charges (partial or total)?
Preauthorization does not guarantee payment. Insurance companies determine payment and what charges will be billed to the patient after a medical claim is filed.
As a friendly reminder that the test has been completed and there is the possibility of some financial obligation from the patient, an invoice will be mailed to the patient after testing is complete. The invoice will indicate that an insurance claim has been filed and no payment is due at this time. A monthly statement indicating an insurance claim is in process will also be mailed to the patient. No payment will be required from the patient until the insurance claim has been processed and closed. Once insurance payment has been received, the monthly statement will indicate the remaining balance and note that the remaining amount is now due from the patient.
The patient is responsible for notifying PreventionGenetics of the status of the explanation of benefits (EOB) and remitting any funds received directly from the insurance company to PreventionGenetics
The patient is responsible for any portion of the test fee not covered by the insurance company for any reason including, but not limited to: co-payments, co-insurance, unmet deductibles, or non-covered services.
How can patients find out how much their insurance will cover?
While a benefit investigation does not guarantee payment, PreventionGenetics can assist with a benefit investigation of insurance coverage. For assistance please complete the insurance benefit investigation form found on our website or call our insurance specialists at 715-387-0484 extension 212.
Where are the specific cpt codes and prices for the test I'm ordering?
A spreadsheet containing CPT Codes and prices for our tests can be found here.
Does PreventionGenetics participate in any Medicare or Medicaid plans?
We are a contracted provider for Medicare and Wisconsin Medicaid. At this time we do not accept any other state's Medicaid.
The patient must meet Medicare criteria for genetic testing in order for the services provided to be considered covered and reimbursable by Medicare. We do require Medicare patients to sign a completed advance beneficiary notice (ABN) in advance of testing to acknowledge financial responsibility should the testing not meet Medicare criteria for covered service. For cancer tests that have specific testing criteria published by Medicare, we do not require an ABN as long as we have sufficient clinical information to support that the patient meets the criteria. Our genetic counseling team can assist with testing coverage details.
Is PreventionGenetics contracted with private insurance companies?
We are a contracted provider for Security Health Plan and HealthChoice (State of Oklahoma). We are also a contracted provider for Wisconsin Medicaid.
Does PreventionGenetics bill institutions?
Yes, PreventionGenetics will invoice the institution or provider directly for the total test fee once the report has been sent to the ordering healthcare provider.
Does PreventionGenetics offer patient self-pay?
Yes, we will bill the patient directly. The individual accepting financial responsibility for the test fees must sign the acknowledgement statement on the Test Requisition Form. The responsible billing party must be at least 18 years old.
We will invoice the responsible individual once testing is complete. Statements showing outstanding invoices and the balance due are mailed, emailed and texted at the end of each month. PreventionGenetics accepts Visa, MasterCard, and Discover. We also accept bank wire transfer, ACH, or check.
Does PreventionGenetics require pre payment for self-pay testing?
No. We do not bill for the test until testing is complete. We do not require a credit card to be on file; however, having a credit card authorization on file allows for easy payment processing once the test has been completed. PreventionGenetics accepts Visa, MasterCard, and Discover. We can also accept payments by bank wire transfer, Automatic Clearing House (ACH), or check.
Does PreventionGenetics offer different pricelists for different payment types?
Regardless of the nature of payment or payer, we strive to provide the lowest prices in the market; therefore, our prices do not vary for different payment options. Our prices are transparent and openly published on our website. We offer three (3) convenient payment options for testing services: we can bill the ordering institution/provider directly (institutional billing); we can bill the patient directly (self-pay); or we can bill the patient's commercial insurance company (insurance billing).
What date of service does PreventionGenetics use?
Date of service (DOS) on the invoice will be the accession date. If the DOS must reflect the date that testing is started (rather than accession date) please contact our billing team to make arrangements.
What are the payment terms?
Payment is due 30 days from the date of the invoice, or 30 days from the date the insurance claim closes. Please contact our billing team to discuss payment plans if necessary.
What happens if we cancel a test?
If you need to cancel a test, please contact our client services department.
What is your National Provider Identifier (NPI) number?
PreventionGenetics LLC NPI Number is 1114140571.