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Natera
THE TESTS
Panorama: cell free DNA that screens for Trisomy 21, Trisomy 18, Trisomy 13. In addition, it can look at the sex chromosomes, certain microdeletions and fetal RhD. This can be ordered any time after 9 weeks. Results usually back in 5-7 days
Horizon: screens for genes associated with specific inherited genetic conditions. It can test for up to 274 conditions. We will suggest ordering the Horizon 14 specifically, as it covers the most common conditions and meets ACOG recommendations. This can be ordered any time before, during or after pregnancy. It should not be repeated in every pregnancy. Results usually back in 14-21 days.
Fetal Focus: single gene NIPT for autosomal recessive carrier screening conditions when Mom is positive on Horizon. This will be ordered as a "reflex" test, in that once ordered, it will only be run under certain circumstances.
Ordering the tests:
Natera order panel.pdfNotes:
In the billing section ALWAYS check "bill insurance" regardless of whether they are uninsured or are a charity patient.
In addition, for the carrier screen you should fill out the FOC portion IF he is readily available and willing to do the carrier screen if patient's is positive.
The preferred method for carrier screening is to screen FOC if MOC is positive. Using Fetal Focus without FOC carrier screen is acceptable but NOT preferred. If the FOC is NOT available you could write that in the comments to avoid confusion.
We currently have the "combo boxes" of Panorama/Horizon/Fetal Focus and Panorama only boxes and a box that is Panorama/Horizon/Fetal Focus. We do NOT have a Horizon/Fetal Focus box only. We are suggesting ordering all 3 to make things easiest for now. If a patient has already had a carrier screen done with Natera for a previous pregnancy, they will not re-run it even if ordered. The boxes are located in the Red Team pod in the upper middle cabinet.
If a patient has had a carrier screen with Unity or Myriad in the past and it was negative, you DO NOT need to reorder Horizon. If the patient's carrier screen was positive on Unity or Myriad, you DO need to reorder the Horizon if you want to be able to run Fetal Focus. For example, a patient is carrier for CF on a Myriad test and FOC also positive. In this case you MUST run a Horizon as otherwise Fetal Focus does NOT work to test baby for CF.
Workflow
Order the tests (as outlined above)
Give patient the test box. These are located in the Red Team pod in the upper middle cabinet.
Instruct patient to go downstairs to the lab WITH the box for a blood draw. Please encourage them to go immediately after appointment. The lab will NOT be stocking the boxes so if a patient forgets it at home they won't be able to get the test done.
Await result. All results will result in Epic. Please call patient with result and document.
Financial options
Medicaid: 100% covered
Private insurance: covered benefit but patient may have copay/deductible to cover so can choose to pay out of pocket instead
Panorama/horizon/fetal focus: $349. This can be decided at a future time, you DO NOT need to worry about this during patient visit.
Charity: The tests will be reduced or no cost depending on criteria from the US poverty guidelines. Patients will be asked for a W2, an income tax return or a pay stub. If a patient has no documents, there is a waiver that the provider can sign and the tests will be provided for free.
Results
Panorama and Horizon come back through Epic as a result.
If Horizon is positive, an order will also come through the provider portal for FOC testing. If no FOC was identified, Fetal Focus will automatically be run.
If Panorama is reported as high risk: refer to MFM
Fetal Focus results will come back through the portal only. Select members of each clinic have access to this.
For Partner (FOC) Carrier Screening:
If you have a patient who is interested in testing for the FOC, please contact our Karina for assistance. She will help you with getting the paperwork completed for the partner testing.
Other Helpful Info:
Natera has a financial assistance program. When the order reaches Natera, they pull the insurance directly from Epic. Based on that they will provide an estimate. If the patient is under or uninsured they will be invited to send paperwork for reduced self pay prices. This billing information will be provided by TEXT. (The initial text is in English, if they accept it then they can choose Spanish.) The patient will be sent a text after the order is received, the patient MUST "opt in" when asked in order to receive the information. In the event that an uninsured patient is unable to provide financial documentation, there is a form available that providers can sign stating the patient is on our charity program and that they cannot afford the test.
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