Ambry’s billing policy has been updated and will be effective October 1, 2015. Our new policy supersedes all current hard copy documents available. We have discontinued the "Billing FAQ" brochure. We have also created a short brochure to help you understand an Explanation of Benefits (should you receive one), and this is found below.
We still preverify insurance coverage (with or without your sample) for genetic testing. If you have any questions, our Billing department can be reached by phone at 949-900-5795 or by filling out the form found here.
"Explanation of Benefits" brochure
We remain committed to working with you and your patients to make the genetic testing process as simple and cost-effective as possible. If your patient would like to discuss his/her Explanation of Benefits (EOB), please contact the Billing Department at (949) 900-5795.
Medical Professional Notice Regarding Medical Necessity and Billing Compliance
Learn how to consolidate your send-out tests with Ambry and immediately lower your laboratory operating budgets.
Obtain information about setting up an institutional account.
Insurance Billing & Insurance Preverification Requests
Obtain information about insurance billing or complete a Preverification Request Form to have us verify your patient’s insurance coverage and out-of-pocket share of cost. Alternatively, you may complete our online automated form for this here
. Our Preverification team will typically be able to send you an estimate in approximately 72 hours.
We work with the majority of Medicaid plans and most require pre-verification for genetic testing. Please submit for pre-verification by faxing the completed Test Requisition Form
We are a contracted provider with Medicare. For genetic tests for which Medicare has specific testing criteria, the patient must meet Medicare criteria. If the patient does not meet the explicit Medicare criteria, a completed Advance Beneficiary Notice (ABN) is required. Our Pre-verification department can verify coverage and provide you with testing coverage details.
Medicare patients are able to have the following next generation sequencing (NGS) cancer panel tests if they meet the specific criteria for each test, as explained below: (Please click here for more information)
- To be eligible for Medicare reimbursement for BRCAPlusTM, BreastNextTM or OvaNextTM, the patient must meet Medicare BRCA1/2 testing criteria and not have previously had BRCA1/2 testing
- To be eligible for Medicare reimbursement for ColoNextTM or RenalNextTM, the patient must meet Medicare Lynch Syndrome genetic testing criteria and not have previously had Lynch Syndrome genetic testing
- To be eligible for Medicare reimbursement for CancerNextTM or PancNextTM, the patient must meet Medicare criteria for BRCA1/2 or Lynch Syndrome genetic testing and not have previously had BRCA1/2 or Lynch Syndrome testing
- To be eligible for Medicare reimbursement for PGLNextTM, please submit for preverification
As you know, Medicare does not currently cover any screening genetic tests for patients who have never had an associated cancer diagnosis. We are not able to bill Medicare if the patient is unaffected and genetic testing is being ordered based only on family history.
Obtain information for patients who will be paying for testing out-of-pocket (due to no insurance or other coverage).
Obtain information about sending in samples from outside the U.S.
Post-Mortem Genetic Testing
The cost of genetic testing can often be a barrier to post-mortem testing. Insurance companies may not cover this cost because the patient is deceased, but there have been reports of insurance coverage in some situations. If insurance coverage is denied or is not an option for your patient, we offer reduced pricing for post-mortem genetic testing.
- Authorization – An approval to perform testing by the insurance company
- Preverification – A service Ambry provides to our clients to obtain benefit information (out of pocket costs) and coordinate authorization requirements.
- Insurance Verification Representative – An Ambry employee who is specialized in obtaining insurance benefits and approvals.
- OOP – Out of Pocket Costs to the patient
- ABN – Advanced Beneficiary Notice
- LOA – Letter of Agreement
- LMN – Letter of Medical Necessity
- Payer – Insurance Company
- Carrier – Insurance Company