Complete the Order

1 To print the specimen requirements page when you print the requisition, select the Print Specimen Requirements check box.

If you do not want to print that page, clear that check box. Selecting or clearing this option applies only to this order, but you can change the default selection via your user profile.

The specimen requirements page contains a list of all of the specified order codes and test names, along with the preferred specimen and minimum volume for each. The specimen requirements page may also summarize the number of containers to collect from the patient, and provide additional details regarding the tests assigned to each container.

Notes:   • The specimen requirements page is never printed for generic orders, and might not be printed for certain non-electronic labs, no matter how this option is set. • If you are creating a standing order, selecting or clearing this check box has no effect. No specimen requirements page is printed when you create a standing order.

2 If you attached an image (as described in Add Attachments) and you want to print the attached images when you print the requisition, select the Print Attachments check box.

If you do not want to print those images, clear that check box.

Any change applies only to this order. You can set the default value for this option via your user profile.

3 In the Print x Labels box, type the number of labels that you want to print (if it differs from the displayed value).

Notes:   • If you are using Entree II labels, this box does not appear; you cannot override the default number of labels to print. • For information about setting the default number of labels to print for each test, see Specifying the Number of Labels to Print. • If you are creating a standing order, specifying the number of labels has no effect. No labels are printed when you create a standing order.

4 Do one of the following:

Note: If the Bill Type is Insurance (and eligibility verification did not occur previously), when you click any of the following, a message will appear and you will not be able to continue if the insurance carrier is known to not pay for Quest Diagnostics testing. To continue, click Previous and change the Bill Type to Patient, or follow your usual procedure for turning away the patient if they do not agree to pay.

• File the order. If you collected a specimen and want to complete the order at this time, click File.

Note: If you entered an order code for a handling fee and the insurance carrier allows you to collect a payment for that fee, a message appears indicating that the order code and carrier you entered have been changed. You can collect the payment for that fee when you save the order. The order code for the handling fee must be submitted on a separate order from any other order codes; you will need to remove any additional order codes and submit them on a separate order.

• Schedule the order for the future. If you did not collect a specimen and specified a date in the Scheduled: Date box, click Schedule.

• Put the order on hold. To put the order on hold, click Hold.

• Put the order on PSC hold. To put the order on hold and print a lab order confirmation letter that the patient can take to a Quest Diagnostics PSC, ASP, or PSA facility to have the specimen collected there, click PSC Hold.

Notes: • This option is available only if you are accessing an IOP facility, your lab supports it, and you are not creating a standing order. • You cannot put a generic order on PSC hold. • If you click PSC Hold, any specified collection date or time is removed from the order.

• Split the order. If the lab supports this feature, and you want to complete part of the order now and put part of the order on hold (for example, if the order requires both blood and urine specimens, but the patient was unable to void), follow these steps:

a Click Split Order.

Notes: • If this order contains donor or post-transplant tests in addition to other clinical tests, the Split Order window opens automatically, with the other clinical tests preselected to be split to a separate requisition and placed on hold. Orders containing donor or post-transplant tests should also include a shipping kit code so that expedited FedEx shipping can be used (during normal business hours) to send the specimens directly to the performing lab. • If this is a Blueprint for Wellness order, if it contains any tests that are being routed to a different lab, or if it is being placed with a generic lab, the Split Order button is inactive. Those types of orders cannot be manually split.

b Select the check box for each test that you want to put in a separate held order.

You must select at least one check box, but you cannot select all of them.

c In the list, click the appropriate comment.

This comment applies to all of the selected tests, and will appear on the requisition and in the requisition log for the original order.

Note: For orders containing donor or post-transplant tests, the appropriate comment is selected automatically.

d Click OK.

Notes:   • To prevent a test from being put in the separate held order, click for that test in the Profiles/Tests area. • If you subsequently add a test that is automatically routed to a different lab, none of the tests will be put on hold, and the Split Order button will become inactive. Orders with tests being sent to multiple labs cannot be manually split. However, if you override the primary lab and choose your current lab, the Split Order button once again becomes active, and you can repeat this procedure to split the order.

e Click File.

Notes:   • If you click Hold, or if you schedule the order for the future and click Schedule, the order is not split. Instead, the entire order is put on hold or on the scheduled orders list. If necessary, you can split it when you edit that held or scheduled order. For more information, see Managing Held Orders and Managing Scheduled Orders. • All of the information from the original order is copied to the held order except for the tests that were not selected, arrival time, visit type, report comments, fasting status, volume, duration, and accession number.

• Save the standing order. If you selected the Standing Order check box, do one of the following:

• To save the standing order without immediately placing an order for the first specimen, click Save SO.

• To both save the standing order and immediately place an order for the first specimen, click Save SO+Order.

Note: If the client is an LTC client, or if the start date for the standing order is in the future, the Save SO+Order option does not appear.

For information on managing standing orders, see Managing Standing Orders.

5 If the Physician Attestation Informed Consent dialog box appears, and the order included a signed Physician Attestation of Informed Consent (PAIC) form, click Yes. If that form was not included, click No. Then click OK.

If you click Yes, the requisition will indicate that a PAIC was received.

6 If the Verify Order Code Info box appears, complete the missing data and then click Save.

For information about completing this dialog box, see one or more of the following sections:

• Provide AOE Data

• Provide Template Data

• Provide Pap Information

• Respond to the ABN Prompts

• Respond to the ICR Prompts

• Indicate the Specimen Type

Note: If you did not previously view or complete the Pap data, you are prompted to do so at this time. However, Pap data are not required to complete the order. If you do not have any additional information, simply click the Pap tab and then click Save to proceed.

7 If all of the information on the Verify Order page is correct and no additional information or action is needed, click Save. Otherwise, do one or more of the following, and then click Save:

Notes:   • If a message indicates that there is a discrepancy between the AOE data and the information in the order, you can either change the AOE data to match the order, change the order to match the AOE data, or proceed with the order as is. • For in-office phlebotomist (IOP) users, if a message indicates that 1 or more pair(s) of diagnosis codes on the order cannot be reported together according to ICD-10 Excludes 1 guidelines, click Previous to modify the order based on the client’s input. Alternatively, you can select the ICD-10 Excludes 1 Exception check box and have the client provide supportive documentation of an exception for the 2 conditions that are unrelated to each other. • If a message indicates to either add a draw fee code or select Draw Fee Not Required, click Edit in the Profiles/Tests area to take one of those actions. • If your single accession order includes at least one test that requires preauthorization (and your current lab is configured to not allow single accession orders requiring preauthorization), the Request Accession Number check box is automatically cleared and appears grayed out. The order will be processed as a regular electronic order. • If a message advises you to take a non-required action (such as adding a comment), you can click Previous to modify the order as instructed or proceed with it as is. • To cancel the order at this point, click Previous and then click Cancel.

• Modify the order. To change any of the displayed information, click Edit in the appropriate area. For example, to change the patient’s address, click Edit in the Patient Information area. To change the tests or AOE data, click Edit in the Profiles/Tests area.

If you click Edit in the Patient Information, Guarantor Information, or Insurance Information areas, the appropriate dialog box appears. Make any necessary changes and click OK.

If you click Edit in the Order Information, ICD Diagnosis Codes, or Profiles/Tests areas, the Order Entry page appears. After you make any necessary changes, you must click File, Hold, PSC Hold, Schedule, Save SO, or Save SO+Order again to return to the Verify Order page.

• Provide a preauthorization code. If a test requires patient counseling or preauthorization from the insurance carrier, type the appropriate code for each listed test. If you do not have a preauthorization code, leave this box blank. You can add the code later (as described in Add or Change a Preauthorization Code, Managing Held Orders, or Managing Scheduled Orders).

If eLabs determines that an approval is already on file, a message appears informing you to proceed with the draw. (In this case, you do not need to enter a preauthorization code.)

• Provide a shipment tracking number. If the order contains a donor or post-transplant test, which requires expedited shipping of the specimen to the lab, type the tracking number of the corresponding shipping kit in the FedEx Tracking # field. A tracking number is required to file the order.

• Provide the patient’s driver’s license number. If a Driver’s License / Government Issue Id field appears and is not already populated, ask the patient to provide their driver’s license number or other government-issued ID number, and type it in the box. (You can also modify an existing value, as needed.)

Notes: This field does not appear if the patient has a Social Security Number already defined.

• Review and respond to the accession information. If an Accession Questions area appears, follow these steps:

a Select the Request Accession Number check box to request an accession number when you click Save.

If you clear this check box, an accession number will not be requested, and the order will be processed like a standard order—that is, a standard requisition, labels, ABN (if any), and specimen requirements page (if appropriate) will be printed—and it is not necessary to complete any of the fields in the Accession Questions area.

b If the Attachment Labels box appears, type the number of accession labels to print.

c If prompts appear for the ordered codes, click the appropriate response for each one.

d If a prompt appears asking you to indicate whether or not the patient has multiple requisitions, select the appropriate response, which determines whether or not you can continue with an electronic quality check. (This prompt only appears if the current lab and facility support electronic quality checks and an electronic signature pad is detected.)

If the request for an accession number is successful, the requisition, labels, and ABN (if any) will include the patient’s name and an accession number, and the specimen requirements page (if printed) will include accession information rather than the standard Directory of Services (DOS) information.

Notes:   • If any tests are inappropriate (for example, if you ordered a pediatric test for an adult), a message appears, and you will not be able to continue. Click Previous, make any appropriate changes to the order, and complete the order again. • If an order code is changed to Default Service Assigned (DSRV), click Confirm, review the order, and complete the order again. • If the order includes any test(s) that cannot use accessioning (such as a Pap test), the order will be split to enable any clinical tests to use accessioning. Any non-clinical tests that are split to a separate requisition can be handled as a standard order. • Accessioned orders are not split based on specimen condition. • If the request for an accession number is not successful, a standard requisition, labels, ABN (if any), and specimen requirements page (if appropriate) will be printed.

• Share the pricing information with the patient. If prices appear in the Pricing Information area, share that information with the patient. Pricing information can include a separate price for each test or service, as well as a total estimated cost for which credit card payment can be authorized via Quest Diagnostics Easy Pay™. The total estimated patient responsibility (based on their insurance coverage, including co-pay and deductible) also appears below the estimated total cost.

For some clients, a Paying at Time of Service prompt appears in the Pricing Information area. If you click Yes and Bill Type is currently set to Patient, it will automatically change to Insurance, and the Third Party Discount (TPDIS) carrier will be used. (If the TPDIS carrier is currently being used, no change is made.) If you click No and the TPDIS carrier is currently being used, Bill Type automatically changes to Patient. (If the order is currently being billed to the patient, no change is made.) In both cases, the bill type does not change until after the order is filed. (It will not be apparent on the Order Entry page, but will be reflected on the requisition.) After you click either Yes or No, an attempt is made to retrieve pricing information. If the patient is paying at the time of service, a discount is applied.

If pricing information is retrieved, you will be prompted to provide payment or credit card authorization information later.

Note: Under certain circumstances, if no email address is currently specified for the patient, a message appears at the top of the Verify Order page. If the patient wants to provide an email address, in the Patient Information area, click Edit. On the Edit Patient Information dialog box, type the patient’s email address in the Email box, and then click OK. The Verify Order page appears again, and you can proceed with the order. (An email address is not required, but adding one at this time ensures that it appears automatically in the payment application, as well as for future orders.)

• Correct the guarantor’s address. If the Address Validation area indicates that the guarantor’s address is not correct, do one of the following:

• Click Edit, type the correct information on the Edit Guarantor Information dialog box, and click OK.

• In the list, click the reason why the guarantor address was left as is.

• Click the option button for the correct address.

Notes:   • In some cases, the guarantor’s address is automatically updated to conform to US Postal Service terminology standards (for example, Street might be changed to St). • If the Use Patient’s Address check box is selected on the Edit Guarantor Information dialog box, any changes made to the guarantor’s address are made to the patient’s address as well. • If you retrieved the patient via a bridge, no changes are made to the external system.

8 After you click Save on the Verify Order page, do one of the following:

• If you clicked File on the Order Entry page, go to step 10.

• If you clicked Schedule on the Order Entry page, go to step 9.

• If you clicked Hold or Save SO on the Order Entry page, no further action is needed at this time.

When you are ready to complete the order, you must file it and print the requisition and labels. For more information, see Managing Held Orders or Managing Standing Orders.

Note: If the order includes any tests that were routed to a different lab, the order is split, and each order is put on hold for the appropriate lab. For example, If the order includes one test for the TMP lab and one test for the MIA lab, then an order for the first test is put on the TMP hold list, and an order for the second test is put on the MIA hold list. Any orders for a generic lab are put on the hold list for the associated lab.

• If you clicked PSC Hold on the Order Entry page, follow these steps:

a If the Print dialog box appears, make any appropriate changes, and then click Print.

If that dialog box does not appear, take the appropriate action on the Lab Order Confirmation Letter dialog box to display the Print dialog box and print the letter. The procedure for doing that varies, depending on your version of Adobe Reader.

Tip: Your user profile controls whether or not the Print dialog box appears automatically.

b Click Close and give the letter to the patient.

Note: If a message on the Lab Order Confirmation Letter dialog box indicates that preauthorization is required for one or more ordered tests, additional information might be printed with the letter. Be sure to review this information.

• If you clicked Save SO+Order on the Order Entry page, the page automatically displays all of the information associated with the standing order so that you can provide information about each ordered test (as described in steps 4–5 in Specify a Test) and then complete the order (as described in steps 1–8).

9 If the ABN or AWN options page appears, do one of the following:

• Allow the patient to sign electronically. If the patient is present and willing to sign electronically:

a Allow the patient to review and select one of options to be applied to the ordered test(s).

If multiple tests are included on the order, the patient can also click More Options to select a separate option for each test.

b Allow the patient to click in the Signature field and then sign their name on the electronic signature pad.

c For an ABN, allow the patient to click the date; only the current day can be selected. (For an AWN, the current day is selected automatically.)

d When the patient's selections and signature are completed, click Accept.

Note: If the patient selected Option 3 (for an ABN) or Option 2 (for an AWN) for a test code, the corresponding refusal code defined for the lab is added to the order, and the associated order code is removed.

• Indicate that the patient is present, but cannot sign electronically or declines to do so. If the patient is present but either cannot sign electronically or declines to do so, click No Electronic Signature, click either Patient Unable to Sign Electronically or Patient Unwilling to Sign Electronically, and then click Accept.

The ABN or AWN form will print (for the patient to sign) and the Attachments dialog box will appear, allowing you to scan the completed form.

• Indicate that the patient is not present. If the patient is not present (for example, the specimen was dropped off by the provider), click No Electronic Signature, click the appropriate Patient Not Present reason, and then click Accept.

The Signature field is populated with the selected reason and the order is filed.

10 If the Payment at Time of Service dialog box appears, use your normal procedure to submit payment information and then close that window. The Close button is not enabled until all required fields have been filled out, unless there is an error in communications with the billing system. (It might take a few moments to access this application.) Otherwise, go to the next step.

Closing the dialog box by clicking the Emergency Close Only link that appears in the lower-right corner should only be done in scenarios such as the billing system being down. Use of this link is tracked.

Note: If you inadvertently close the Payment at Time of Service dialog box, you can return to this dialog box later by clicking Payment or Authorize when the Requisition page or dialog box appears. (Those buttons are inactive if it is not appropriate to collect that information at this time.)

11 If the Quality Check - Samples Collected page appears, proceed with the draw. When you are finished, do the following:

a To view or print the specimen requirements page, click Print Specimen Requirements.

b In the Specimen Collection Summary box, review the samples collected and update as needed, and then click Continue.

c On the Quality Check - Patient Verification page, do one of the following:

• Allow the patient or authorized designee to review the patient information and sign electronically. If the patient or authorized designee is present and willing to sign electronically:

i Allow the patient to click in the Patient Signature or Authorized Designee field and then sign their name on the electronic signature pad.

An authorized designee must click the appropriate Authorized Designee/Relation to Patient option, print their name (appears in the Printed Name field), and then click in the signature field to sign their name.

The current date is selected automatically.

ii Click Done.

• Indicate that the patient is present, but declines or is unable to sign electronically. If the patient is present but does not want to sign electronically, click No Electronic Signature, click either Patient Unable to Sign Electronically or Patient Unwilling to Sign Electronically, and then click Accept.

Note: The No Electronic Signature button does not appear if the order included an ABN or AWN.

The Patient Verification form will print (for the patient to sign) and the Attachments dialog box will appear, allowing you to scan the completed form.

• Indicate that the patient is not present. If the patient is not present (for example, the specimen was dropped off by the provider), click No Electronic Signature, click the appropriate Patient Not Present reason, and then click Accept.

The Signature field is populated with the selected reason and the order is filed.

Note: If the order contains multiple requisitions but you did not indicate this on the Verify Order page, you can do so now by selecting the Multiple Orders check box. Selecting this check box disables electronic quality check (these orders do not appear on the Quality Check page), and a Patient Verification page prints. You must complete the fields at the top of the form, and then have it reviewed and signed by the patient. You must then scan and attach the completed form to the requisition (after filing the order) via the requisition log; for details, see Add Attachments.

12 On the Print dialog box, make any appropriate changes and then click Print to print the requisition and any supporting documents (such as the specimen requirements page or ABN). Alternatively, to review the requisition and/or supporting documents before printing, click Cancel and go to the next step.

Under certain circumstances, the order might be split into multiple requisitions.

For scheduled orders, the requisition displays the word DRAFT, and any template image appears on a separate page. You can print the draft requisition now, or you can print the final requisition when you file the scheduled order. For more information, see Managing Scheduled Orders.

Any labels print automatically.

Notes:   • If the phrase Batching-No Reqs appears at the top of the page, 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 templates are included, you are not prompted to print the requisition. Instead, the Order Entry page appears again. The order is sent to the batch queue so that you can create batches and print the batch manifest (as described in Managing Batches). • If you scheduled specimen collection for the future, and a test in the order was routed to a generic lab, a separate generic requisition is generated for that test. That requisition does not include a collection date or the word DRAFT. In addition, that portion of the order is filed rather than added to the scheduled orders list.

13 When the Requisition or Supplemental Documentation page or dialog box appears, do one or more of the following:

• Browse through or print the requisition and/or supplemental documentation. Use the appropriate procedure for your version of Adobe Reader.

Note: If the quality check was signed electronically, the Supplemental Documentation initially appears. You can then toggle between the supplemental documentation and the requisition by clicking Show Requisition and Show Supplemental, respectively.

• Reprint the labels. To reprint the labels, do the following:

a Click Reprint Labels. (This button does not appear if Make/Model is set to None on the Label Printer tab in your user profile.)

b On the Reprint Labels dialog box, specify the number of reprints for each label type that appears, and then click Print. (The maximum number you can specify for each is 9.)

• Provide payment information. If you were not previously prompted for payment information, and the patient is paying at this time, click Payment, use your usual procedure for submitting payment information, and then close the window.

Notes:   • If this feature is not supported, the Payment button does not appear. • If it is not appropriate to collect payment information at this time, the Payment button is inactive.

• Provide credit card authorization information. If you were not previously prompted for credit card authorization information, and the patient will be paying by credit card later, click Authorize, use your usual procedure for submitting credit card authorization information, and then close the window.

Notes:   • If this feature is not supported, the Authorize button does not appear. • If it is not appropriate to collect credit card authorization information at this time, the Authorize button is inactive. • The patient’s credit card is not charged at this time. The patient will be charged for the actual cost when it is incurred.

• Provide co-payment information. If a co‑payment is required by the patient’s carrier, click Co-Pay, use your usual procedure for submitting co-payment information, and then close the window.

• Return to order entry or the Check-In Queue. Click Return on the Requisition page, or click Close on the Requisition dialog box.

Notes:   • If a message on the Requisition page or dialog box indicates that preauthorization is required for one or more ordered tests, additional information might be printed with the requisition. Be sure to review this information. • If an ABN or AWN is required, have the patient select the appropriate check box(es) and sign and date the form. (This can be done electronically, if enabled, or the form will be printed along with the requisition.) For a printed form, if all of the ordered services cannot fit on a single page, multiple pages are printed and the patient must complete each one. The information on the ABN or AWN might not match the information on the requisition. For example, the ABN or AWN might use a different name for the test, or the listed panel components might not be identical. • For insurance draw orders, one or more forms may print along with the requisition, which the applicant must sign. Have the applicant review, sign, and date the forms, and then submit the signed forms along with the requisition.

14 If the ABN Validation or AWN Validation dialog box appears, click the Yes or No option button for each prompt, indicating whether or not the patient signed and dated the form.

Note: If the patient completed and signed the ABN or AWN electronically, this dialog box does not appear.

If you click No for any of these prompts, click the most appropriate reason why the ABN or AWN was not properly completed, then click Save.

15 If you collected a specimen, affix the label to the specimen container, and send both the requisition and specimen to the lab. (If the quality check was signed electronically, the requisition is submitted automatically.) Be sure to include any printed ABN or AWN as well, unless it was completed and submitted electronically.

If you printed the specimen requirements page, do not send that to the lab.

Note: If the client uses batching, you must create batches in order to send the order to the lab electronically. For more information, see Managing Batches.

16 If you initiated the order from the Check-In Queue, click Done for the appropriate patient.