Get Cologuard Order Form

Filling out the Cologuard Order Form online can streamline the process of ordering this important test. This guide will walk you through each section of the form, ensuring you provide all necessary information accurately and efficiently.

Follow the steps to complete the Cologuard Order Form.

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. In the Provider Information section, enter the name of the healthcare organization, location address, provider name, city, state, zip, NPI, secure fax number, and phone number. Please ensure all information is typed clearly.
3. Under Test Information, select the test name 'Cologuard'. Confirm that you are a licensed medical professional authorized to order the test and affirm its medical necessity for the patient. Record the relevant ICD-10 codes and make sure to include any other applicable codes.
4. Sign and date the Order section to validate the request. Ensure your signature is legible.
5. In the Patient Authorizations, Assignments of Benefits & Financial Responsibilities section, have the patient sign and date to authorize billing to their insurance provider. This includes the assignment of all rights and benefits to Exact Sciences Laboratories.
6. Complete the Patient Information section by entering the patient's ID/MRN, first and last name, date of birth, contact numbers, email address, and optionally their language preference.
7. Fill in the Patient Address section with the shipping and billing addresses. Ensure that the city, state, and zip codes are accurate.
8. In the Patient Insurance/Billing Information section, provide the policyholder name and date of birth, and indicate their relationship to the patient. Specify the type of insurance and fill in the insurance carrier details as required.
9. Once all sections are completed, review the form for any errors or missing information. Save your changes, and ensure it is ready for submission.
10. Finally, fax the completed form to 844-870-8875 as directed.

Start filling out the Cologuard Order Form online today for a seamless ordering experience.