Payment Options

Billing/Payment Options

Metametrix and Genova Diagnostics have combined efforts in a shared mission to apply a systems-based testing approach to the diagnosis, treatment, and prevention of complex chronic disease. Together, we offer a variety of patient-friendly billing options, including:

• Insurance
• Patient Prepay
• Clinician Billing
• Medicare

Please Note: Effective immediately, BCBS of Georgia will begin following its Association Ancillary Billing Guidelines as mandated by the Blue Cross and Blue Shield (BCBS) Association of all BCBS licensees nationally. The change will affect patients whose healthcare providers (HCP) practice outside the State of Georgia. This means that Metametrix will accept assignment of BCBS claims for Georgia and Federal Employee (FEP) BCBS subscribers ONLY. For more information, please contact us.

Insurance

Metametrix Insurance Billing programs allow patients to enjoy the benefits customarily associated with traditional insurance-reimbursed medical services. We now offer three Insurance Billing options to make the payment process simple, based on insurance type and testing ordered. The details of each program are outlined below:

• Bill Insurance (contracted providers)
• PrePay Advantage (prepayment with courtesy insurance claim filed)
• EasyPay (GI Effects and ION Profiles ONLY)

Please contact us for more information.

Missing information can result in the delay of test results.

1. Bill Insurance: Metametrix Contracted Insurance

As of October 14, 2012, Metametrix is a contracted (in-network provider) for patients with the following plans:

• Blue Cross Blue Shield
• Blue Cross Blue Shield (BCBS) Federal Employee Program (FEP)
• Blue Cross Blue Shield of Georgia

For these patients, NO PAYMENT IS DUE with specimen submission.

Other contracted insurance plans include:

• Highmark Blue Cross Blue Shield
• CareFirst Blue Cross Blue Shield
• Blue Cross Blue Shield of New Jersey
• Blue Cross Blue Shield of Kansas City

To reduce delays and errors in processing insurance claims, the following information is required:

1. A copy of the patient's valid insurance card
2. A signed and completed Test Requisition Form. In Responsible Party Insurance Information section, please be sure to provide all required information AND a copy of the insurance card. Missing information can delay test results.
3. Appropriate ICD-9 codes A listing of codes can be found at www.metametrix.com/icd9
4. A valid NPI number of the ordering clinician

Missing information can result in the delay of test results.

2. Bill Insurance: PrePay Advantage

For Metametrix to complete the complimentary filing we require the following:

• Patients must include the PrePay Advantage payment (payment of the pre-pay price), insurance information, front and back copy of insurance card.
• Metrametrix must receive the diagnosis code(s) and valid NPI number from the referring health care practitioner on the Requisition.
• A claim will be submitted to the patient's insurance company directing payment to them.
• Failure to include all necessary information may result in exclusion from the program and patients will be responsible for filing the claim to insurance.

PrePay Advantage Eligible Insurance (as of 10/10/12)

• Aetna
• Humana
• Principal
• Kaiser
• Tufts
• Blue Cross Blue Shield of North Carolina for all Blue Cross Blue Shield members receiving services from Health Care Practitioners in North Carolina.
• BCBS Federal Employee Program (FEP) except when contracted. Please refer to contracted insurance section below for details.

Please note:

• The special Patient Prepay price is due, in full, at the time of specimen submission. Missing information and/or payment will delay test results.
• Filing this courtesy claim does not guarantee reimbursement from the insurance provider.
• If the claim is denied, the patient will be notified by Metametrix and an Explanation of Benefits (EOB) will be provided by his/her insurance provider. It will be the patient’s responsibility to deal directly with the insurance carrier regarding any errors, omissions, or appeals.

For more information on this value-added service, please contact Client Services at 800.221.4640.

Please note that not all insurance plans are applicable for PrePay Advantage.

Missing information can result in the delay of test results.

3. Bill Insurance: EasyPay Program (GI Effects and ION Profiles ONLY)

As a result of our integration with Genova Diagnostics, a new insurance billing option is available for eligible patients using our GI Effects and ION profiles.

Using this option, patients with an eligible insurance plan (select non-contracted plans) who are completing an EasyPay-eligible test profile(s) can enjoy the benefits customarily associated with traditional insurance-reimbursed medical services.

To avoid being billed at list price for qualifying services, eligible patients should follow the EasyPay Guidelines listed below.

• Patients must submit the EasyPay amount, their insurance information, a copy of their valid insurance card (front and back), and their collected specimen to Genova Diagnostics.
• Genova Diagnostics files the insurance claim on behalf of the patient.
• Once the patient’s insurance claim is processed, an Explanation of Benefits (EOB) will be provided by the patient’s insurance carrier. Patients will be billed for any remaining balance not covered by their insurance carrier, as indicated in the EOB.
• Most insurance companies will provide payment and an EOB directly to Genova Diagnostics; however, some insurers, such as Blue Cross & Blue Shield, pay patients directly. If the patient is paid directly, he/she is required to forward the insurance payment and a copy of the EOB directly to Genova Diagnostics. If Genova Diagnostics is unable to determine the application of benefits by the patient's insurance plan, the patient is required to provide a copy of the EOB to Genova Diagnostics as well.

For more information on the EasyPay guidelines, please consult the flyer inserted in your kit, visit www.gdx.net/billing or contact us.

Missing information can result in the delay of test results.

Patient Prepay

Using this option, an insurance claim WILL NOT be filed AND payment of the special prepay price is due, in full, with specimen submission and a signed, completed Test Requisition Form (TRF). A receipt for payment will be mailed directly to the patient.

If out-of-network insurance information is provided, a complimentary filing will be done by Metametrix under the PrePay Advantage program.

Acceptable forms of payment are:

• Visa/MC/AMEX/Discover
• Money Orders
• Checks made payable to Metametrix, Inc. (Only checks drawn from a U.S. bank are accepted)

Please note:

• We do not bill patients who choose to utilize the Patient Prepay option. Payment is due, in full, with specimen submission.
• We do not file insurance claims for Worker's Compensation.

Missing information can result in the delay of test results.

Clinician Billing*

Using this option, a patient pays his/her clinician directly for testing services. Accordingly, the clinician becomes responsible for payment and will be billed by Metametrix. Please contact your physician directly to discuss this option.

*Exceptions - New York (NY), New Jersey (NJ), and Rhode Island (RI): Clinicians in NY, NJ, and RI are prohibited (by the laws of each respective state) to bill patients for laboratory services. In these states, patients are encouraged to select our Patient Prepay option. PrePay Advantage is also available for certain insurance plans within these states.

Missing information can result in the delay of test results.

Medicare/Medicare Advantage

Currently, we are under contract as an in-network provider for patients with Medicare and Medicare Advantage coverage. For these patients, NO PAYMENT IS DUE with specimen submission.

Please note: Test profiles that are considered diagnostic or necessary to aid physicians in diagnosing conditions are listed below. Important information on All Other Tests is also listed below.

(Diagnostic) Test Profiles Potentially Eligible for Coverage:

GI Effects

• 2100 GI Effects Complete Profile – Stool
• 2105 GI Effects Microbial Ecology Profile – Stool
• 2110 GI Effects Mycology Profile – Stool
• 2115 GI Effects Parasitology Profile – Stool
• 2120 GI Effects Chemistries Profile – Stool

The GI Effects Profile is used to identify gastrointestinal disorders.

ION

• 0090 Individual Optimal Health - Blood & Urine
• 0090 Individual Optimal Health Pediatric - Blood & Urine

The ION Profile is used to determine the basis for chronic health conditions.

Cardio ION

• 0290 Cardio ION - Blood & Urine

The Cardio ION Profile is used to determine the basis for chronic health conditions with cardiovascular risk markers.

All Other Test Profiles

Coverage eligibility for remaining test profiles will be at the discretion of Medicare. However, Medicare is NOT expected to cover tests that do not appear on the Potentially Eligible list (shown above).

Things to Consider

• For tests other than our GI Effects Profiles, Patient Prepay may be a feasible option for Medicare patients. Medicare Advantage patients may want to select Prepay Advantage.
• If you submit your Medicare information to have Metametrix file a Medicare claim for tests that do not appear on the Potentially Eligible list you may be billed up to list price if Medicare denies the claim (which is most likely). When selecting the Medicare option under this circumstance, the patient will no longer be eligible to receive the prepay price.
• Medicare patients should submit a completed Advanced Beneficiary Notice (ABN) of Non-Coverage for tests not listed on the potentially eligible list.
  • Please select option 1 if you would like us to submit a claim to Medicare. If the claim is denied you will be billed up to the list price of the test.
  • Please select option 2 if you would like to prepay for the test at the discounted prepayment price, a claim will not be submitted to Medicare.
• If choosing to have Metametrix submit a claim on your behalf you must provide your Medicare/Medicare Advantage information.
• If Medicare denies the patient’s claim, the patient or responsible party will be notified, will receive an Explanation of Benefits (EOB), and will be billed for the outstanding balance.

Missing information can result in the delay of test results.

National Provider Identifier (NPI)

A NPI is required, per HIPAA mandate, for all insurance claims to be filed. The NPI is a unique identification number for covered health care providers. The NPI must refer back to the ordering clinician in order to be valid. Also, per HIPAA mandate, covered providers must share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. Please verify that the ordering clinician has a National Provider Identifier prior to utilizing insurance options.

Price Quoting

Metametrix does not disclose pricing per our agreement with Metametrix clinicians. Please consult with your physician on any questions regarding pricing.

Missing Information

If required information and payment are not received, test results may be delayed. Please review the table below to be sure that you are providing everything necessary to process the billing/payment option that you have selected.

*Metametrix will bill the patient (or responsible party) for any outstanding balance not covered by Medicare or insurance.

**An ABN is required for tests that Medicare classifies as being used for screening purposes (as opposed to being used to identify a specific diagnosis). For Metametrix branded tests, all test profiles require an ABN with the exception of GI Effects Profiles.