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Contract Managed Care/Insurance Billing

We are contracted with many national health plans, though we are not contracted with HMO plans or many smaller regional plans.

We strongly recommend contacting our billing coordinator prior to submitting a sample to arrange insurance billing.  Faxing the patient's Insurance Card ahead of time will allow us to verify the contract status.

The following documents are required to bill a contracted insurance plan.  All required items must be received prior to test initiation.

 Copy of patient's insurance card, front and back

 Letter of medical necessity from referring physician
 Billing Consent form

 Authorization letter (if required by the insurance plan), including the authorization number and CPT codes authorized.     OR

 If no authorization is necessary, note the name and extension of the plan employee who provided this information.  

Remember:  patients are responsible for any applicable deductable, co-pay, or co-insurance.  

A note about CPT codes:
As many of our tests for rare diseases are using the unlisted code (81479), we anticipate an increase in denials of coverage.  Verification of coverage of the test codes is required, and patients should be informed of the possibility of insurance denials. 


Links to Forms

Billing Consent Form
Sample letter of medical necessity
Checklist for creating a letter of medical necessity

 

Please note:  We are not able to bill non-contracted plans, even if the plan authorizes the medical service.