Get the free Oncotype DX TM Request Form - Blue Cross and Blue Shield of ...

Ecotype DTM Request Form Member Name Member ID Requesting Physician Contact Name Phone Number (Fax Number ()) The member named above has requested coverage of Ecotype DX. BCB SNC will provide coverage

How to fill out oncotype dx tm request

How to fill out an oncotype dx tm request:

1. Begin by ensuring you have all the necessary information and documents for the request. This may include the patient's medical history, pathology reports, and relevant diagnostic test results.
2. Fill out the patient's personal information accurately, including their name, date of birth, and contact details. It is crucial to provide these details correctly to avoid any confusion or delays in the testing process.
3. Provide the patient's insurance information, including their insurance carrier, policy number, and any required authorization or pre-certification details. This step is essential to ensure the testing is covered by insurance and avoid any unforeseen costs.
4. Include the ordering physician's information, such as their name, contact details, and medical license number. It is crucial to provide accurate details to maintain proper communication between the physician and the laboratory conducting the oncotype dx tm test.
5. Specify the procedure or test being requested, which in this case is the oncotype dx tm test. Provide any additional details or specific instructions, if necessary, to ensure the requested test is performed accurately.
6. If the patient has a follow-up appointment scheduled, include the date and time on the request form. This information helps the laboratory prioritize the testing process based on the patient's upcoming appointment.
7. Review the completed request form for any errors or missing information before submitting it. Double-check all the details to guarantee all necessary information has been provided accurately.

Who needs an oncotype dx tm request?

1. Patients who have been diagnosed with breast cancer may require an oncotype dx tm request. This test helps evaluate the likelihood of cancer recurrence and the potential benefit from chemotherapy.
2. Oncologists and physicians who are treating breast cancer patients may request an oncotype dx tm test to guide treatment decisions. The test results provide valuable information on the patient's individualized risk assessment and can help determine the most appropriate treatment plan.
3. Insurance companies or third-party payers need an oncotype dx tm request to process coverage for the test. This ensures that the cost of the test is eligible for coverage and avoids any unexpected expenses for the patient.

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What is oncotype dx tm request?

Oncotype DX is a genomic test that analyzes the activity of a group of genes in a patient's breast cancer tissue to provide information about how likely the cancer is to recur and how likely it is to benefit from chemotherapy.

Who is required to file oncotype dx tm request?

Oncotype DX is typically requested by a patient's oncologist or breast surgeon to help guide treatment decisions.

How to fill out oncotype dx tm request?

The oncologist or breast surgeon will need to collect a tissue sample from the patient's breast cancer and send it to the laboratory that performs the Oncotype DX test.

What is the purpose of oncotype dx tm request?

The purpose of the Oncotype DX test is to provide personalized information about the patient's breast cancer, including the likelihood of recurrence and the potential benefit from chemotherapy.

What information must be reported on oncotype dx tm request?

The requested information typically includes the patient's medical history, details about the cancer diagnosis, and any other relevant clinical information.