Billing Payment Options 2009
CMA (Pre/Post-natal) Billing Policy
Personal Medical Genomic Profile
Prenatal Biochemical & DNA Comprehensive Charge
International Client
Payment Options
Cancellation Policy
Contact Information & Tax ID
Texas Medicaid Approved Tests
Prices and CPT Codes
Laboratory
Managed Care Contracts (PDF)
Authorization for Use and Disclosure of Protected Health Information
Institution
Agreement Form (PDF)*
Credit
Card Payment Authorization Form (PDF)*
Tax
ID W-9 Form (PDF)*
Statement
of Medical Necessity
Advanced
Beneficiary Notification
Baylor College of Medicine, Medical Genetic Laboratories Billing Operations provides convenient billing programs for our valued clients. We offer the following full service Billing Services and Payment Options.
Institutional Billing
Referring clinics, hospitals, labs, and/or physicians may establish Institution accounts with convenient monthly invoicing and payment options (excluding international clients-see below). A completed Institution Agreement Form and Business Services Agreement must be on file in the Billing office for account approval. You may select the option to establish an institution credit card payment account. Please direct all institution billing inquiries to
or call 713-798-5849.
Insurance Billing
- Complete insurance information is required on the patient requisition form including legible front/back copy of insurance cards, ICD9 codes, and a Statement of Medical Necessity.
- Tests received without complete insurance information, required HMO authorization, and signature for Release of Information and Benefits cannot be billed to insurance. Testing is not initiated until complete information is received including the referral source ICD9 code.
- HMO authorizations/referrals are required. Please contact our office for assistance and approval prior to securing HMO authorization for your patient
- Insurance verification is performed only when specifically requested for non-contracted insurance providers. Please follow the link to see full list of managed care contracts. Insurance verification and preauthorization are not a guarantee of payment.
- Patients may be fully liable for fees due to insurance benefit coverage limitations, contract exclusions, non-covered services, non-authorized services, deductibles, co-pay insurance, or balances after insurance reimbursement. Affordable payment terms for insurance balances may be arranged through billing office staff at .
- Limited insurance filing is performed for Preimplementation Genetic Diagnosis and Personal Medical Genomic Profile tests. These tests require prepayment with sample. Insurance is filed as a courtesy. Complete insurance information and medical indication must be received with sample.
- Tests received with institutional billing instructions cannot be revised to bill insurance.
Medicare:
Limited genetic tests are approved to bill Medicare. An Advanced Beneficiary Notification is required for approved Medicare samples. Please contact prior to test submission.Texas Medicaid:
Texas Traditional Medicaid does not reimburse genetic laboratory tests therefore the Medical Genetic Laboratories cannot accept Texas Traditional Medicaid.
The Medical Genetics Laboratories can only bill contracted Texas Medicaid Managed Care programs. Texas Medicaid Managed Care samples are subject to prior authorization approval. Please follow the link to see the list of Texas Medicaid Managed Care program approved genetic tests. An approved authorization for service must be received with Texas Medicaid Managed Care samples. Please contact our office directly (713-798-8923) for additional information prior to securing authorization for genetic lab testing.Tricare (Champus): Medical Genetics Laboratories are not contracted with Tricare military insurance.
Letters of Agreement-Single Case Agreements-Prior Authorizations:
Billing office staff must be contacted prior to developing agreements or authorizations. These agreements or authorizations must reference specific contract language, terms, and information which our staff will provide. Agreements or authorizations developed without this information will not be accepted. The Medical Genetics Laboratories do not accept Medicare rates on Letters of Agreement or Single Case Agreements.
Self-Pay Prepayment (see Credit Card Payment Authorization Form):
The Medical Genetic Laboratories accept checks (payable to Baylor Genetics), money orders, and approved credit card (AMEX/Discover/MasterCard/Visa) payment. Prepaid patient samples are eligible for a prompt payment discount. It is not permitted to file insurance on discounted fees.
Prepaid Samples
Prepaid samples receive a prompt pay discount when required payment is received with the sample. We accept checks, money orders, credit card payments, and wire transfers. Please make checks and money orders payable to the Medical Genetics Laboratories. There is a $20.00 processing fee for insufficient check payments.
Exclusion: Preimplementation Genetic Diagnosis and Personal Medical Genomic Profile tests are required to be prepaid with sample. Prepayment discount does not apply to these tests.Credit Card Payments
Approved credit card (AMEX, Discover, Mastercard, or Visa) payments are accepted. The card type, cardholder name and signature, credit card account number, expiration date, CVC security code, and e-mail address must be provided.Wire Transfers
Payments can be made via wire transfer from your bank. The bank identification information is referenced below. Please notify our business office (713-798-5849 or ) when a wire transfer is performed. The wire transfer information:Recipient Bank Information:
JP Morgan Chase Bank
717 Travis, 8th Floor South
Mail Code: 8-CBBS-302
Houston , TX 77002
Phone: 713-216-0404Swift Code: CHASUS33
Account Number: 30100015903
ABA Number: 113000609
Credit: Baylor College of Medicine, General Account
Reference: Medical Genetic Labs
Chromosome Microarray Analysis (CMA) Prenatal & Postnatal Billing Options:
- Self-Pay Prepayment
- Institution Billing to an approved Institution Account.
- Insurance Billing:
- All conditions of standard insurance filing apply to CMA.
- A Letter or Statement of Medical Necessity from the referring MD is recommended for CMA tests filed to insurance.
- Patients may be fully liable for fees due to insurance benefit coverage limitations, contract exclusions, non-covered services, non-authorized services, deductibles, co-pay insurance, or balances after insurance reimbursement.
- CMA is not billed to Texas Medicaid or Medicare.
Personal Medical Genomic Profile (PMGP)
- Self-Pay Prepayment
- Authorized Institution Billing to an approved Institution Account.
- Insurance is filed as a courtesy only. The PMGP test must be paid-in-full at sample submission. Complete insurance information must be received with sample.
- PMGP is not billed to Texas Medicaid or Medicare.
Prenatal Biochemical & DNA Comprehensive Charge:
One standard fee is charged for prenatal tests performed by biochemical or DNA procedures. The comprehensive charge includes testing on the maternal, fetal, and paternal samples. Twin samples are charged two standard fees. This does not apply to prenatal diagnoses performed by the Cytogenetics Laboratory or Prenatal CMA. Please contact our genetic counselors at 1-800-411-4363 prior to prenatal sample submission.
International Client Payment Options:
Important Note for our International Clients: Individual international samples must be prepaid at the time of sample submission. You may submit check, money order, credit card, or wire transfer payment with single samples.
International Payment Options:
Prepaid Samples
Prepaid samples receive a prompt pay discount when required payment is received with the sample. We accept checks, money orders, credit card payments, and wire transfers. Please make checks and money orders payable to the Medical Genetics Laboratories. There is a $20.00 processing fee for insufficient check payments.
Credit Card Payments
Approved credit card (AMEX, Discover, Mastercard, or Visa) payments are accepted. The card type, cardholder name and signature, credit card account number, expiration date, and e-mail address must be provided.
Wire Transfers
Payments can be made via wire transfer from your bank. The bank identification information is referenced below. Please notify our business office (713-798-3295 or
) when a wire transfer is performed. The wire transfer information:
Recipient Bank Information:
JP Morgan Chase Bank
717 Travis, 8th Floor South
Mail Code: 8-CBBS-302
Houston, TX 77002
713-216-0404
Swift Code: TCBKUS44
Account Number: 30100015903
ABA Number: 113000609
Credit: Baylor College of Medicine, General Account
Reference: Medical Genetics
Financial Office Contact:
Barbara Daniel
Phone: 713-798-3295
Fax: 713-798-4187
P.O. Box 4832
Houston, TX 77210-4832
Cancellation Policy:
Test orders must be cancelled before 5:00pm (central time) the next business day after the sample is received. Cancellation orders received after that time cannot be honored. Tests will be performed, charged, and reports issued. This includes tests cancelled for billing (financial responsibility) issues:
- Call Client Services 1-800-411-4363 or 713-798-6555 for cancellations or revisions.
- A Test Cancellation/Revision Form will be faxed to your institution for an authorized signature. Upon completion, please fax form to 713-798-6584.
Mailing Address & Contact Information:
| Billing Name: | Baylor Genetics |
| Financial Office Contact: | Barbara Daniel |
| E-mail: | |
| Phone: | 713-798-3295 |
| Fax: | 713-798-4187 |
| Address: | P.O. Box 4832 Houston, TX 77210- 4832 |
| Tax ID: | 74-1613878 |
| National Provider ID (NPI): | 1770635864 |