PCDx Billing Process & FAQ

PCDx Billing

Paradigm wants to assist physicians in providing the best medical care by helping every patient get access to the highest quality genetic testing, because we know how beneficial it can be. We also want patients and their families to be able to focus on treatment, and not have to be distracted by finances. We are committed to doing all we can to help you receive the maximum allowable benefit from your insurance company. Paradigm currently accepts all insurance plans, although we are not in-network with all providers.

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Billing Documents

PCDx Billing FAQ

The Paradigm process

1

Your physician will order PCDx, and will provide your insurance information to Paradigm with the testing requisition.

2

Paradigm staff will contact pathology to have your tissue specimen sent for testing.

3

Testing takes approximately 4-5 business days after receipt of the specimen. Once complete, Paradigm will provide the PCDx test result back to your physician’s office for review.

4

Paradigm will bill your insurance company for the test as the Provider of Service. It typically takes up to 90 days for insurers to respond to claims. During this time you will receive an Explanation of Benefits (EOB) from your insurer. An EOB is not a bill, but reflects the various tests that were billed to your insurance.

5

Many insurance providers will initially deny coverage for some or all testing. Paradigm will work on your behalf to resubmit claims or pursue appeals to maximize payment from the insurer and minimize the amount (if any) that is owed by the patient. During this time we may have to contact you or your physician for assistance.

6

Your insurer will send payment to Paradigm, with instructions for how it should be applied. Patients may be responsible for deductibles, co-payments and/or co-insurance according to the terms of their individual health care plans and federal or state regulations. We will do all we can to minimize these out of pocket charges.

7

If there is a balance remaining on the account after payment from the insurer is received, we will send a statement to you with the amount outstanding. We encourage you to call our Billing Specialist at 844-232-4719 to review the charges, repayment and financial assistance options.

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