Order Entry

Depending on how your user account was set up by an administrator, you might be able to place orders with just one lab, or with multiple labs. If you can place orders with multiple labs, one of them will be your default lab (that is, the lab that you access automatically each time you log into eLabs). If you can access multiple labs, you can choose which one to use for each order.

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.

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 rehabilitation facility or nursing home. Clients are associated with one or more particular labs, so during order entry, you can specify only those clients that are associated with the lab that is performing the tests.

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.

For PSC employees, the Home Draw check box and Visit Type list do not appear on the Order Entry page for LTC clients. For both PSC employees and IOPs, the Arrival box does not appear.

House Accounts

Most labs have at least one client known as a house account. A house account is not a healthcare provider, but rather a client that you can specify when placing orders for patients who are not affiliated with any other clients of your current lab. House accounts are typically used for out-of-town patients.

During order entry, you can add a new patient or retrieve an existing one. An existing patient can be retrieved under the following circumstances:

• 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

Patient information can reside in two locations: the eLabs database and the master patient database (MPD). In the eLabs database, each client has its own patient records, and it is possible for different clients to have different demographic information for the same patient. In the MPD, there is one master record for each patient across all of the labs and clients.

All universal and non-electronic labs rely exclusively on the eLabs database for their patient information. All other labs can be configured by an administrator to retrieve patient information from only the eLabs database, or from both the eLabs database and the MPD. (Some labs might retrieve information from only the eLabs database, but still send patient information to the MPD. Whenever a patient is added to the MPD, that patient is given a Quest Diagnostics Health ID.) The configuration of the lab affects how information is presented on the Patient Search - Advanced Results dialog box that appears when you search for a patient.

Whether or not you specify a client before searching for the patient, the search encompasses all of the clients at your current lab. You can optionally control whether or not the search encompasses all of the labs that you can access by selecting or clearing the Search My Labs check box. In addition, if two or more records are determined to be for the same patient, that patient is listed only once.

When you search by patient ID, the search is performed only in the eLabs database, even if the lab is configured to use both the eLabs database and the MPD. Searching by name searches both databases.

The list of matching search results from the eLabs database includes the following patient information:

• Quest Diagnostics Health ID (if any) and SSN (if any)

• Name (LastName, FirstName) and street address (if any)

• City and state (if any)

• Zip code (if any)

• Date of birth and age

• Email address and/or phone number (if any)

Notes:   • By default, patients with pending orders are listed first. You can subsequently change the sort order. • For universal and non-electronic labs, the Health ID column does not appear. • The SSN is masked except for the last four digits. • If you have an active bridge and are allowed to search the external system by name, the search is performed only in the external system, no matter how the lab is configured.

When you search for the patient by Health ID, the search is performed only in the MPD. (You can search by Health ID only for labs that support the MPD.) In this case, there will be only one matching master record (as indicated by a gold star).

Whether you search by name or Health ID, the list of matching search results from the MPD includes the following patient information:

• Health ID

• Name (LastName, FirstName) and street address

• SSN, if any (masked except for the last four digits)

• Date of birth and age

• Sex

• Phone number or email address

If the lab supports both the eLabs database and the MPD, and matching results exist in both locations, a splitter bar appears on the Patient Search - Advanced Results dialog box. Matching master patient records from the MPD appear above the splitter bar, and matching search results from the eLabs database appear below it. (You can move the splitter bar up or down by clicking it and dragging it to the desired position.)

Notes:   • The MPD search results are based only on the patient’s last name, not first name. For example, if you search for doe,a, the MPD search results will include all patients with a last name of Doe, no matter what their first name might be. This ensures that a person who goes by multiple first names (such as Anthony and Tony) is not excluded from the search results based on first name. • Certain words (such as Baby, Boy, Girl, Husband, Patient, and others) are not treated as names in the MPD, and any individuals with those names (such as James Boy) will never be included in the MPD search results.

If a patient in the eLabs database is identified as the same patient in the MPD, only the master patient record from the MPD appears. (The patient might appear briefly below the splitter bar while results are being obtained from the MPD.) If a particular patient exists in both the eLabs database and the MPD, but the two records have not yet been identified as the same person, then both records appear—one above the splitter bar, and one below. If the record below the splitter bar has pending orders, be sure to choose that record rather than the master patient record; this ensures that the pending orders become attached to the master patient record.

If the patient exists only in the eLabs database, a message indicates that no data was found in the MPD, and the matching search results from the eLabs database appear below the splitter bar. As soon as you choose the patient and place an order, that patient is typically added to the MPD and given a Health ID, and will appear above the splitter bar in future searches.

Notes:   • Only patients with an address are added to the MPD. If the client is being billed or the order is put on hold and no patient address is specified, that patient will not be added to the MPD nor given a Health ID. • 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. This applies only to the eLabs database, not the MPD. Patient records in the MPD are retained indefinitely.

Patient Information Updates

If the retrieved patient information needs to be modified (for example, if the patient has moved), you can update it during order entry. As soon as you complete the order, the change is saved and will appear the next time that you place an order for that patient for that client. (The date and time when the patient record was last updated appears at the bottom of the Patient Information area.)

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 unless you are changing the master patient record in the MPD.

When you place an order for an existing client, that client will always receive the test results electronically via eLabs. The client might also receive them via mail or fax, depending on how the account was set up. In addition, you might be able to have an additional copy of the test results sent to other recipients, 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 eLabs.) When you place an order for a house account, you must have a copy of the test results sent to an additional recipient, such as the ordering provider.

When you click Add Recipients on the Order Entry page, the Total copies allowed area indicates the total number of additional copies of the test results that can be sent. You can always send up to the total number of copies allowed to existing clients via the preferred delivery method that was specified by that client when the account was established. (This is referred to as the method on file.) Depending on the lab, you might also be able to send a certain number of test results via mail, fax, or Direct messaging.

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.

Note: Test results are never sent to a house account, even though it appears among the recipients as the ordering client.

If the patient or an insurance carrier is being billed for the test, you must provide guarantor information. If the patient has insurance, you must also provide insurance information (such as the name of the carrier and the insurance ID). The information that you are prompted for varies by the carrier. For example, the name of the ordering provider might be required for one carrier, but optional for another. (The client being used for the order determines which bill types are supported, and some clients are restricted to specific carriers.)

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 Order Entry page.

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 Order Entry page.

• 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 Order Entry page, and the associated generic lab appears in parentheses after the carrier’s name. When you choose a generic carrier, the selected lab does not change, but the order is not sent to that lab electronically. Instead, a generic requisition is printed, which can be sent to the generic lab. However, a record of the order is maintained in eLabs for reference purposes.

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.

In addition, for certain clients, if Bill Type is set to Patient and the patient pays at the time of service, Bill Type automatically changes to Insurance and the Third Party Discount (TPDIS) carrier is used. The next time that you retrieve the patient, the TPDIS carrier is used automatically. However, if you specify a client in a location that does not offer the discount, or if the patient does not pay at the time of service in that instance, Bill Type automatically changes back to Patient (assuming that the client supports that bill type).

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. • You can also verify a patient’s insurance coverage before placing an order. • 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 Order Entry page, the 15 most frequently used diagnoses automatically appear in the Client Favorites group. Any diagnoses used for the patient within the past year appear in the Patient Specific group. (You can optionally hide the Client Favorites group via your user profile.)

You can use a written diagnosis (that is, a diagnosis that is not associated with a specific ICD code), if the lab and your facility type support this feature.

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. On the Order Entry page, the 15 most frequently used tests automatically appear in the Client Favorites group. (You can optionally hide that group via your user profile.

During order entry, you can specify a maximum of 15, 25, 35, or 100 order codes, depending on what the lab supports. You can also view detailed information about any test, including the preferred specimen, minimum volume, transport container and temperature, specimen stability, test methodology, and clinical significance. (This feature is not available for generic or client-defined tests.)

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. You can order tests that exactly match handwritten order translations, but not aliases.

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.

Special Order Codes

In addition to the standard order codes, you can place orders using special codes:

• Draw fee codes. If your facility charges a fee for collecting a specimen (referred to as a draw fee), you are required to specify the draw fee code when placing an order to ensure that the responsible party is billed for that fee. Each facility might have multiple codes for different fees (for example, one code for collecting a specimen at the PSC, and a different code for performing a house call).

When you include a draw fee code when placing an order, any site-specific suffix associated with the facility is automatically appended to that code to identify the facility that generated the fee. For example, at the AB facility, if the draw fee code is 3259 and the site-specific suffix is XAB, when you include the code 3259 in an order, the requisition displays 3259XAB.

• In-house test codes. Certain tests can be performed directly at your facility rather than at the lab; these are referred to as in‑house tests. In‑house tests use the same base order code number as the tests performed at the lab, but include a suffix to indicate where the test will be performed. For example, at the AB facility, if you place an order for code 6399, the test would be performed at the lab. However, if you place an order for code 6399XAB, the test would be performed at the AB facility.

A single base order code number can have multiple suffixes. For example, whe n the code 6399 has a suffix of XAB, the test would be performed at the AB facility. When it has a suffix of RWD, it would be performed at the RWD facility.

• Clarify codes. With some handwritten orders, it can be difficult to determine exactly which test the physician requested, and if the physician cannot be immediately contacted for clarification, it might be more efficient to proceed with ordering a particular test and contact the physician later. Quest Diagnostics has defined a set of codes known as clarify codes. These codes use the base order code for the test followed by a suffix, typically CL. If your facility supports clarify codes, you can use those codes when placing orders, and the lab will contact the physician for additional details.

If pricing is enabled for the lab, facility, and carrier (if applicable), the base code is used to retrieve the pricing information for any code that contains the letters CL. For example, if the clarify code is 6399CL, then pricing information is retrieved for the base code of 6399. (For labs that use a different suffix, such as C, to identify a clarify code, pricing information is not retrieved.)

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 the client receives.

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 Order Entry page. However, when you file the order, an additional recipient is added to the requisition. This recipient is the Quest Diagnostics reporting group that will be preparing the personalized report. If you add the maximum allowed number of recipients during order entry, you are prompted to remove one of them when you complete the order. This ensures that the test results can be sent to the reporting group when the order is filed.

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 a home draw or 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. Likewise, if you split the order manually, the reporting group is added as a recipient only for the order that contains the wellness code. 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. If you order a test that requires informed consent, and the ordering provider has not already signed a Physician Attestation of Informed Consent (PAIC), you are prompted to indicate whether or not a signed PAIC form is included with the order. Information about informed consent also appears in the Directory of Services (DOS) for each affected test or panel.

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.

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.

At the end of the order entry process, you must file the order, put it on hold so that it can be completed later, or schedule it for the future. If you created a standing order, you can simply save it, or save it and initiate an order for the first specimen. Your options are determined in part by the responses you provided as you placed the order, in part by how the client is configured, and in part by your role.

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 Order Entry page, then when you file the order, you are prompted to print the requisition. The labels are printed automatically, and the order is sent to the lab electronically (unless you are ordering the tests from a generic or non-electronic lab).

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 original order was a held, scheduled, or standing order, this will be indicated in the upper right hand corner of the requisition.

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.

Notes:   • Messages related to batching never appear when you are accessing a PSC or PSA facility; they can appear only when you are accessing an IOP facility. Orders placed by PSC employees and contracted phlebotomists are never put in the batch queue. • 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. In some cases, you might have to provide only the client number, patient’s name and date of birth, and a test. When you put an order on hold, no requisition or labels are printed. When you are ready to file the order, you can retrieve it from the hold list, file it, and then print the requisition and labels.

Alternatively, if you are accessing an IOP facility, you can put the order on hold and print a letter that the patient can take to a PSC, ASP, or PSA facility to have the specimen collected there. (This feature is available only if the lab supports it, and only if the order is not being placed with a generic lab.)

Manually Splitting an Order

If the lab supports this feature, you can manually split an order before filing it. For example, if the order requires both blood and urine specimens, but the patient cannot void, you can put the tests that cannot be immediately addressed on a separate held order.

The held order includes all of the information provided in the original order, except for the tests that were filed, arrival time, visit type, report comments, internal comments, fasting status, total volume, duration, technician’s initials, and accession number. Whether or not the lab reference ID is included varies, depending on the client.

When an order is manually split, appears next to the requisition number in the requisition log, and you can view information about the order in the Manually Split Requisition area when you expand the order. This symbol also appears on the Patient Search - Advanced Results dialog box for the order that was put on hold.

In addition, the hold list indicates which orders were manually split from another order.

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).