LabCorp InformaSeq Test Detects Common Fetal Trisomies

We're pleased to advise that Laboratory Corporation of America® (LabCorp) has developed InformaSeqSM, an advanced, non-invasive, next generation prenatal test (NIPT) to assess the risk of fetal trisomies in pregnant women. InformaSeq is offered through Integrated Genetics, a member of LabCorp's Specialty Testing Group and a leading provider of reproductive genetic testing services.

We encourage providers to use LabCorp's InformaSeq for NIPT.

The use of InformaSeq is consistent with and supported by Horizon BCBSNJ's medical policy, Noninvasive Prenatal Testing for Trisomy 21 Using Cell-Free Fetal DNA. This policy is available for review in our online Medical Policy Manual.

Previously, LabCorp offered both the InformaSeq and the HarmonyTM NIPTs. However, effective December 12, 2014, LabCorp/Integrated Genetics will only offer the InformaSeq test. If you have questions, please contact your LabCorp representative.

We understand that there are several nonparticipating clinical laboratory providers that offer similar NIPT services. However, as a participating provider, you are required to refer Horizon BCBSNJ patients or send their testing samples to a participating clinical laboratory provider.

Laboratory Corporation of America® is a registered mark of Laboratory Corporation of America® Holdings.
InformaSeqSM is a service mark of Laboratory Corporation of America® Holdings.
HarmonyTM is a trademark of Ariosa Diagnostics, Inc.

Use participating providers, including clinical laboratories
We remind you that Horizon BCBSNJ members have lower out-of-pocket costs when they use participating providers. We always encourage our members to stay in-network whenever possible. However, the decision to choose a participating clinical laboratory provider is not always within the member's control.

We rely on participating providers to refer their Horizon BCBSNJ patients or forward their testing samples to participating clinical laboratories. The agreements we maintain with participating clinical laboratories help us manage the costs associated with laboratory services.

As a participating provider, you have agreed to comply with our policies and procedures, including referring Horizon BCBSNJ patients and/or sending their testing samples to participating clinical laboratories.

Please also ensure that you comply with the requirements outlined in our Out-of-Network Referral Policy in the event that you refer any patients enrolled in Horizon BCBSNJ plans that include out-of-network benefits to any nonparticipating provider.1

Our Out-of-Network Referral Policy is available online. Log in to NaviNet.net, mouse over References and Resources, click Provider Reference Materials and:

• Click Policies and Guidelines.
• Click Administrative Policies.
• Click Out-of-Network Referral Policy.

1 Our Out-of-Network Referral Policy applies to all participating physicians and other health care professionals in the Managed Care and/or PPO networks who make referrals for health care services to Horizon BCBSNJ members/covered persons enrolled in products that include out-of-network benefits, including POS, DA, PPO [including Federal Employee Program® (FEP®) plans], State Health Benefits Program (SHBP) and School Employees' Health Benefits Program (SEHBP) plans, and Horizon Medicare Advantage plans.
 

LabCorp and Horizon BCBSNJ
For members enrolled in Horizon BCBSNJ managed care and EPO plans, LabCorp is the exclusive in-network clinical laboratory provider.

• Participating Horizon Managed Care Network physicians and other health care professionals are required to send testing samples and/or refer patients enrolled in Horizon BCBSNJ managed care plans that do not include out-of-network benefits (Horizon HMO, Horizon EPO, etc.) to LabCorp.*
• Patients enrolled in Horizon BCBSNJ managed care plans that include out-of-network benefits (Horizon Direct Access, Horizon POS, etc.) use their in-network benefits when you refer them or send their testing samples to LabCorp and their out-of-network benefits when sent to other clinical labs.
  
  Participating Horizon Managed Care Network physicians and other health care professionals may only refer Horizon BCBSNJ patients enrolled in managed care plans that include out-of-network benefits (or send their testing samples) to a clinical laboratory other than LabCorp if:
   
  • That patient chooses to use his or her out-of-network benefits, and
  • The participating Horizon Managed Care Network physician or other health care professional follows the requirements outlined in our Out-of-Network Consent Policy.

Participating Horizon Managed Care Network physicians and other health care professionals who do not comply with our Out-of-Network Referral Policy will be at risk of an audit.

If you have questions about laboratory services or our Out-of-Network Referral Policy, please contact your Horizon BCBSNJ Network Specialist.

*Pathology services provided in a hospital setting to members enrolled in Horizon BCBSNJ managed care plans by a practice that participates in the Horizon Managed Care Network are allowed as an exception to the above-described LabCorp exclusivity requirements.