Order Entry
Depending on how your user account was configured by an administrator, you might be able to place an order using only legacy order entry, both legacy and streamlined order entry, or only streamlined order entry.
Both legacy order entry and streamlined order entry enable you to file a complete lab order, create a standing order, schedule an order for the future, and put an order on hold. With streamlined order entry, all of the information in the order appears on a single page, making it easier to see everything at a glance.
Note: Hospital staff members cannot create or manage standing orders. |
If
Although you can provide all of the necessary information during order entry, you might find it more efficient to customize this application before you place any orders so that you are presented with the options that you use most frequently.
Note: To place orders with a generic lab or a non-electronic lab, you might have to define the tests for that lab before you place any orders for it. |
Depending on how your
There are three different types of labs:
• Quest Diagnostics labs, which use the eLabs system to receive their orders electronically
• Other labs that are not affiliated with Quest Diagnostics, but that use the eLabs system to receive their orders electronically (referred to as universal labs)
• Labs that are performing sites in the eLabs system, but that do not receive their orders electronically (referred to as non-electronic labs)
Depending on how the system is configured, you might also be able to place orders with labs that are not performing sites in eLabs (referred to as generic labs). Generic labs are typically associated with specific insurance carriers, which are referred to as generic carriers. When you place an order for a patient who uses a generic carrier, the name of the generic lab does not appear in the Lab list, but rather in the Insurance area on the Order Entry page.
For both generic and non-electronic labs, the order is not transmitted to the lab electronically. Instead, you simply print a requisition, which can be sent to the lab along with the specimen. Although the order is not sent to the lab electronically, a record of it is maintained in eLabs for your reference.
Some of the order entry functions that you can perform vary, depending on the lab that you use. For example, with some labs, you cannot specify secondary insurance.
Note: Streamlined order entry does not support generic labs or carriers. Non-electronic labs and their affiliated carriers are used instead. |
When you place an order, you must specify which client is requesting the test. A client is a healthcare provider; it might be an entire physician practice, a particular office in a practice, or an individual physician. A client might also be a
Depending on how your user account was set up by an administrator, you might be able to place orders for just one client, or for multiple clients. If you can place orders for multiple clients, one of them will be your default client (that is, the one that is typically selected automatically), although you can always choose a different one. You can also specify which client should be your default client via your user profile, or always use a client other than your default client for order entry.
Each client might have different capabilities. For example, some clients allow the bill for the test to be sent to an insurance carrier, the patient, or the client, while other clients support only one or two of those options. Some clients allow orders to be placed with generic labs, while other clients do not. In fact, some clients do not allow order entry at all; you cannot place orders for those clients.
LTC Clients
Some clients are set up by an administrator as long-term care (LTC) clients. These clients are typically nursing homes or similar facilities.
When you create a standing order for an LTC client, you can request a particular draw time, and you must specify the patient’s station and room.
• The patient was previously registered
• An order was previously placed for the patient
• The patient information exists in an external system (such as a PMS or POS), and you have a bridge to that system
Notes: • Hospital staff members cannot use bridges. • After a certain amount of time, if the demographic information for a particular patient has not been updated, and no orders have been placed for that patient, the patient’s record might be removed from the eLabs database. The amount of time that patient records are retained varies by lab. Some labs might keep their patient records indefinitely; others might remove their inactive records after 2–15 years. |
Tips: • If any information is too long to display in its entirety, an ellipsis (...) appears. You can position the pointer over the displayed information to see the complete information. • You can press Ctrl+f to search for text on the Patient Search - Advanced Results dialog box. |
Note: With streamlined order entry, if the same patient has a different patient ID at different clients, the phrase (multiple) appears in the PID column. |
Patient Information Updates
If you change the station or room for a patient of an LTC client, that information is automatically updated in all of the patient’s pending orders, including expired standing orders. (Automatic updates also occur if you change the station or room when editing patient registration information, a filed order, or a pending order.)
However, if you retrieve patient information from an external system via a bridge, the changes are not passed back to that external system. The same information from the external system is retrieved each time unless you update it in that system.
Likewise, any updates that you make to the patient information for one client are not automatically made for any other clients.
When you place an order with a Quest Diagnostics or universal lab, you will always receive the test results electronically via this application. You might also receive them via mail or fax, depending on how your account was set up. In addition, you might be able to have an additional copy of the test results sent to yourself or others, such as the patient or other physicians. (For orders placed with non-electronic labs, that lab determines how the results are sent; they are not delivered electronically via this application.)
When you click Add Recipients on the
If the number allowed for mail or fax is less than the total, then the number allowed for that method appears. For example, if the lab allows a total of four copies to be sent via any mechanism, then Total copies allowed: 4 would appear. However, if the lab allows only three copies to be sent by mail or only two copies to be sent by fax, then Total copies allowed: 4 (3 Mail 2 Fax) would appear.
In addition, the ordering client automatically appears among the recipients, and the Method on File check box is selected and inactive, indicating that a copy of the test results will always be sent to this client via its preferred delivery method. This does not count toward the total number of additional copies allowed. If the lab supports this, the Fax check box can appear for the ordering client, even if Total copies allowed: 0 appears. This ensures that you can still fax the test results to the ordering client. For Companion Diagnostics standing orders, the Mail or Fax check box may also selected (and inactive) for some ordering clients, and this does count toward the total number of copies allowed. This ensures that the ordering client receives a copy of the tests results, since instances of Companion Diagnostics standing orders are filed with a national Companion Diagnostics client rather than the ordering client.
All carriers are associated with specific labs, so the list of available carriers varies, depending on which lab is performing the tests. eLabs includes three different types of carriers:
• Standard carriers. These carriers have a contractual agreement with the selected lab to cover the cost of the tests at a particular rate, and are available to all of the clients of that lab. Standard carriers appear in green on the
Note: For some labs, a carrier that appears in green might be available to only certain clients. |
• Custom carriers. These carriers have been added to eLabs by request, and might be available only to that client, or to all of the clients of the lab. Custom carriers appear in blue on the
• Generic carriers. These carriers have a contractual agreement with a lab that is not a performing site in eLabs. Generic carriers appear in red on the
Note: Streamlined order entry does not support generic carriers. |
Any guarantor or insurance information is saved with the patient record when you complete the order. The next time that you retrieve this patient and place an order for the same client, the information specified for the last order appears automatically, although you can always change it as needed. (You can also change this information via patient registration.)
Discounted Carriers
In some parts of the country, discounted prices are available for services that might not be covered by Medicare or carriers with other insurance coverage rules. If you retrieve a patient and subsequently change the client, the carrier might change automatically as a result. This ensures that if an Advance Beneficiary Notice (ABN) or Advance Written Notification (AWN) is required, it reflects the appropriate pricing based on the client’s location.
Payer-Based Order Routing
In some cases, a particular insurance carrier might want orders to be sent to a particular lab. When you place an order for a patient who uses that type of carrier, the lab might change automatically, although you can override this.
Eligibility Verification
Certain insurance carriers periodically provide information about their subscribers, such as the person’s name, sex, date of birth, address, insurance ID, and other details. If you place an order that is being billed to such a carrier, the system might automatically compare the information provided in the order against the information provided by the carrier. This is referred to as eligibility verification.
The configuration of your user account by an administrator determines whether or not eligibility verification occurs during order entry. If eligibility verification does occur, and there are potential problems, you will see one of the following messages:
• Eligibility Record Found. Some of the information in the order matches the information provided by the carrier, but there might be discrepancies. For example, if the patient has moved, the address might be different, or the order might be for a patient’s dependent and the system has information only on the parent. You must verify the information in the order and make any necessary modifications.
• Patient Not Covered. The coverage expiration date provided by the carrier precedes the current date (for example, if you are placing the order on 1/14/2019, and the expiration date provided by the carrier is 12/31/2018). You must verify that the carrier specified in the order is correct, and make any necessary modifications.
• Eligibility Record Not Found. The information in the order does not match the information provided by the carrier. This can occur if the patient’s last name has changed, if the carrier specified in the order is not correct, or if the patient joined the plan after the carrier sent its data. You must verify that the information in the order is correct, and make any necessary modifications.
In addition, some carriers have independent practice association (IPA) sub-plans that restrict coverage. For example, some sub-plans cover only patients under 18 years of age, or only patients who live in a particular region. If a patient is not covered according to the terms of the sub-plan, an IPA message to that effect appears below the eligibility verification message. (If the information in the order matches the information provided by the carrier, the eligibility verification message is Acceptable Match.) The look and wording of the IPA message might vary from one lab and sub-plan to another.
Notes: • If eligibility verification occurs, and there are no significant discrepancies between the data in the order and the data provided by the carrier, and no IPA message has to be displayed, you will not see any eligibility verification message during order entry. However, the phrase Acceptable Match will appear on the requisition. • The information provided by the carriers is believed to be correct as of the date it was received. However, the completeness and accuracy of this information cannot be guaranteed. In addition, changes might have occurred between the time that the carrier provided the information and the date of service (for example, the subscriber’s policy might have been terminated or renewed). This information is intended only as an additional resource. |
When you place an order, you typically specify a diagnosis. This information might be required, depending on the client or insurance carrier.
During order entry, you can type or search for a diagnosis code or description, or select the diagnosis from a list of your favorites. On the
When you provide a diagnosis during order entry, you must provide the highest level of specificity. For example, you cannot simply use the diagnosis code 052 (Chickenpox). You must provide a code such as 0529 (Varicella Uncomplicated).
When a diagnosis is not considered appropriate for a patient based on that patient’s age or sex, a message might advise you of this. (You can still file the order.)
For patients who use certain insurance carriers (such as Medicare), the cost of a test might be covered only if a particular diagnosis is specified in the order. For tests that are ordered from Quest Diagnostics or universal labs, you can check the limited coverage policies before you place an order. You can also access similar information during order entry.
When you place an order, you must specify at least one test. Different labs can perform different tests, so the available tests vary, depending on the lab. You can type or search for the order code or test name, or select the test from a list of favorites.
With streamlined order entry, the initially displayed lists of favorite tests (if any) include only those associated with your default lab and client. However, when you type an order code or test name, the search results include all of the matching tests at all of the labs that you can access. As soon as you choose a test, you can subsequently add only tests associated with that same lab. If you need to order some tests from one lab and some tests from another, you must place a separate order for each lab.
For example, if you can access both the Tampa (TMP) and Miami (MIA) labs, and TMP is your default lab, then when you initiate an order, your favorite tests for TMP appear automatically. If you search for glucagon
, the search results will include the order codes for that test for both TMP and MIA. If you choose the test from MIA, the displayed favorites change to your favorites for MIA. If you subsequently search for another test, the search results will include only tests that can be performed by MIA.
During order entry, you can specify a maximum of 15, 25,
If the same test should be performed at regular intervals, you can also provide standing order information
Panels and Custom Profiles
In some instances, a single order code represents a collection of tests for multiple analytes. These are typically referred to as panels. For example, the code 7600 for a lipid panel might include tests for LDL, HDL, HDL‑C, total cholesterol, and triglycerides.
Some labs offer two types of panels: standard panels (which can be ordered by any client) and custom panels (which typically begin with a letter and can be ordered only by specific clients). Custom panels are sometimes referred to as ease‑of‑order panels.
If these predefined panels do not meet your needs, you can streamline the order entry process by creating your own custom profiles, sometimes referred to as ease-of-use panels. Custom profiles can include individual test codes, panels, or both. During order entry, you can view a list of the order codes associated with any custom profile before you add it to the order.
When you place an order, panels codes are treated as a single order code. However, when you specify a custom profile, each component of the profile is ordered individually, and counts toward the maximum number of order codes that you can include in the order.
Aliases and Handwritten Order Translations
To make it easier to find the appropriate codes, some labs have associated certain order codes with commonly used terms known as aliases. For example, an alias for the sucrose hemolysis test might be sugar water.
A handwritten order translation is similar to an alias, but it represents a common name for a test approved by the corporate medical coding team. For example, a handwritten order translation for a plasma glucose test might be fasting blood sugar.
When you search for a test during order entry, both aliases and handwritten order translations are automatically included in the search results, and each is appropriately identified. If the lab does not support aliases, only handwritten order translations are included in the search results.
Restricted or Limited Access Codes
Some order codes are intended for use by only one or more specific clients; these are referred to as restricted codes or limited access codes. If a restricted or limited access code is available for a particular client, then you can order that code. However, if you type or search for that code when placing an order for a client that is not allowed to use it, the code will not be found.
Note: With streamlined order entry, you can add a restricted or limited access code to the order only after you specify the client. (The client is specified automatically if you can access only one, or if you retrieve an existing patient who is associated with your default client.) |
Companion Diagnostics Tests
The Companion Diagnostics program is designed to help physicians determine the best treatment approach based on how the patient responds to specific therapies. For labs and clients that support this program, you can create a standing order for tests that can provide information about therapeutic efficacy. For example, a regularly scheduled CBC can provide insights into how well the patient is responding to a particular drug for anemia or leukemia.
The allowed duration of the standing order is determined by each individual program. For example, some standing orders can last for up to five years. Only tests that are part of the selected program can be included in these standing orders. The tests themselves can be performed at Quest Diagnostics labs throughout the country, ensuring that specimens can still be collected even if the patient is traveling.
When an instance of a Companion Diagnostics standing order is filed, the client automatically changes from the original client to the appropriate national Companion Diagnostics client so that the appropriate client is billed. To ensure that the original client receives a copy of the test results, the Method on File check box is selected and inactive, and the Mail or Fax check box may also be automatically selected and inactive among the report recipients.
Other changes might be made to the order as well. For example, if the test is performed by a different lab because the patient had a specimen collected while traveling, the order codes might change. This information is reflected in the requisition log and in the results report that
Wellness Codes
For clients that participate in the Complete Wellness Program, when you place an order that includes a wellness code, a personalized health report is produced. This report integrates the results of the ordered tests with health risk assessment data or other information about the patient. The report is then sent to the appropriate recipients.
Each lab might have multiple wellness codes for different programs. However, only one wellness code can be included with each order.
When you add a wellness code to an order, you might be prompted to provide additional information, such as the patient’s height, weight, or blood pressure.
In addition, when you add a wellness code to an order, no additional recipient appears on the
Notes: • You can add a wellness code to an order for a client that does not participate in the Complete Wellness Program. However, no personalized health report will be produced in that case. • If there are any problems adding the reporting group to the list of recipients, that group will not appear on the requisition, and no personalized health report will be produced. • If a filed order splits automatically, the reporting group is added as a recipient to each requisition (including the ones that do not contain the wellness code). However, if you schedule the order for the future or create a standing order for an LTC client, and the order splits, the reporting group is added as a recipient only to the requisition that contains the wellness code, and only when the scheduled order is filed. For more information about order splitting, see Order Completion. |
Primary and Alternate Order Codes
For some labs, the same test can be associated with multiple order codes. For example, a CBC might be associated with both codes 6399 and 42A. However, only one code is considered the primary code; all others are considered alternate codes.
Lab orders can include only primary codes. If you specify an alternate code, it is automatically replaced with the primary code.
Order Code Alerts
If important information is available for a particular test (for example, if the test is going to be discontinued or replaced), appears next to the order code when you add it to the order. You can position the pointer over this symbol to view the message.
Additional Test Information
Certain tests have special requirements or restrictions. For example, the lab might need to know where a tissue sample was collected in order to complete the test or report the results properly. If only a few simple responses are needed, the test might be associated with ask-at-order-entry (AOE) or specimen type questions, which you are prompted to complete online. If more complex responses are needed, the test might be associated with a template—a form that you must complete before you can file the order. Most templates can be completed online, but in some cases, a form is printed with the requisition, and you can complete it after you print the requisition. There is also a specialized template for Pap tests. Although you can file an order without completing the Pap template, completing it is recommended.
If the patient uses Medicare and the cost of the test is not expected to be covered—for example, if the test is not considered medically necessary for the specified diagnosis—you are prompted about this as well. If adding another diagnosis to the order is not medically appropriate, or if there are other issues (such as limitations on how frequently a test can be performed), an Advance Beneficiary Notice (ABN) is required when you complete the order. This provides information about the patient’s estimated responsibility for the cost of the test. The ABN must be completed and signed by the patient, and submitted to the lab along with the specimen and requisition.
Other carriers might have similar restrictions. When the insurance coverage rules are known, you are notified of the limitations and prompted to take appropriate action when you order an affected test. In some cases, an Advance Written Notification (AWN) is required when you complete the order. The AWN must be completed and signed by the patient, and submitted to the lab along with the specimen and requisition.
Notes: • For orders placed with generic and non-electronic labs, you can be prompted to complete AOE questions, but you will not be prompted to complete any template, and no validation is performed for Medicare or other coverage. • For tests that are ordered from Quest Diagnostics or universal labs, you can check the limited coverage policies before you place an order. |
Informed Consent
A growing number of states regulate genetic testing.
Tests for Generic and Non-Electronic Labs
You can order a test from a generic or non-electronic lab only if that test already exists in eLabs.
For some national generic labs, the tests are added to the system automatically. However, for other generic labs, you must add the needed tests to the system yourself. You can optionally add tests yourself even for national generic labs.
For some non-electronic labs, all of the tests used by that lab are added to the system automatically, and you cannot add any manually. For other labs, some tests are added to the system automatically, but you can add more tests manually. (These are referred to as client-defined tests.) For other labs, no tests are added to the system automatically, and you must add all of the ones that you want to use manually.
Note: Streamlined order entry does not support generic tests. Non-electronic labs are used instead of generic labs. |
Transport Temperatures
For labs that support this feature, when you order a test, the preferred transport temperature for the specimen appears automatically on the Order Entry page. For some tests, you can change the temperature, but for others you have only one option.
In addition, the preferred transport temperature might vary by lab. For example, one lab might require that the specimen for a particular test be room temperature, and another lab might require that the specimen for the same test be refrigerated.
The descriptions used for the transport temperatures might also vary by lab. For example, one lab might use A (ambient), another might use RT (room temperature), and another might spell out Room Temperature.
If an order includes codes with different transport temperatures, one requisition is created for each temperature group. For example, if the order includes one code whose specimen must be room temperature, and another code whose specimen must be refrigerated, the order would split into two separate requisitions.
Note: Transport temperatures do not appear for generic or client-defined tests. Generic orders are never split into separate requisitions, but orders for non-electronic labs might be. |
Test-Based Order Routing
In some cases, certain tests should be performed by specific labs. When you order a test that should be routed to another lab, the Order Entry page displays the site ID of the lab where each test should be performed, along with the order code used by that lab. You can use the automatically selected lab (and specify the client, generic client ID, and carrier, as appropriate), or you can override it.
Filing an Order
You can file an order only if you provided all of the required information and collected a specimen.
If no message related to batching appears at the top of the
If the order includes both a Pap test and another test that requires a separate specimen, if the order includes at least two specimens that must be transported at different temperatures (such as one at room temperature and another frozen), if the order includes both a client-defined test and a test that has a defined transport temperature, or if one of the ordered tests is associated with a template, the order is typically split, which means that separate requisitions are created for the different tests. (Generic orders are never split.)
If the word Batching appears, you are prompted to print the requisition and labels are printed automatically, but the order is not sent to the lab electronically. Instead, it is sent to the batch queue—that is, a collection of orders that are grouped based on the transport temperature of each collected specimen. When you create batches, the order is then sent to the lab, and you can print the batch manifest (a list of the orders included in each batch). For non-electronic labs, no orders are ever sent to the lab electronically, but the order will not appear in the requisition log until after the batch is created.
If the phrase Batching-No Reqs appears, you are prompted to print the requisition only if the order includes a test associated with a template, or if the patient or an insurance carrier is being billed. If the client is being billed and no template is included, you are not prompted to print the requisition. In all cases, the order is sent to the batch queue so that you can create batches and print the batch manifest.
Note: For orders placed with generic labs, it does not matter whether batching is enabled or disabled for the client. Generic orders are never put in the batch queue. |
Information about filed orders appears in the requisition log. Depending on how the lab is configured and other considerations, you might be able to edit an order after it has been filed via the requisition log.
Putting an Order on Hold
If you do not currently have all of the required information, or if you did not collect the specimen, you can put the order on hold. The amount of information required to put an order on hold varies, depending on the client
Alternatively,
Scheduling an Order
If you did not collect a specimen but specified a draw date, you are prompted to print a draft requisition, and the order is put on the scheduled orders list. When you schedule an order, you do not have to provide all of the clinical information that might normally be required for a particular test, but you must provide that information when you subsequently file the order. When you collect the specimen and file the order, you can print the final requisition.
Like filed orders, scheduled orders might also split into two or more requisitions. When this occurs, each requisition appears separately on the scheduled orders list.
Note: If a batching message appears on the Order Entry page, you cannot schedule the order for the future. |
Saving a Standing Order
If you created a standing order, you can simply save it, or you can both save it and place the first order (as long as the client is not an LTC client and the starting date is not in the future).