Concert links 160,000 genetic tests to coverage criteria, automates accurate payment, and supports high-value clinical test ordering
NASHVILLE, Tenn. (June 9, 2021) – The U.S. Patent and Trademark Office has issued Concert Genetics patent US10,896,405B1 for innovative methods that enable real-time coverage determination and accurate reimbursement of genetic tests, the company announced today.
As the patent describes, Concert’s system converts health plan medical policies, typically text documents, into machine-readable criteria, and then links the criteria to every genetic test on the market. This system leverages Concert’s platform for collecting, standardizing and organizing genetic test information, represented in patent US10,223,501B1. By improving the speed and accuracy of coverage and payment decisions, the capability ultimately shortens the patient’s path to clinically appropriate testing.
“At Concert, we are driving toward the day when coverage determination is instantaneous, accurate payment is automatic, and manual claim review is unnecessary” said Rob Metcalf, CEO of Concert Genetics. “Today, confusion about genetic test coverage and reimbursement leads to burdensome, manual processes that waste time and deliver inconsistent results. Concert can eliminate that confusion and help make cost-effective precision medicine a reality.”
Effective immediately, Concert’s new capabilities will enable more accurate payment of genetic tests for customers of Concert’s real-time claim edits. In addition, they will provide better coverage information in the clinical test selection and ordering process.
“To support high-value, clinically appropriate genetic test ordering, the optimal place to deliver this information is upstream, at the point of care,” said Gillian Hooker, PhD, ScM, LCGC, Concert’s Chief Scientific Officer and immediate Past President of the National Society of Genetic Counselors. “In addition to using these new capabilities to enable accurate reimbursement, we have also begun building them into the clinical test ordering workflow so that providers and patients can determine with confidence whether or not a genetic test will be covered ”
A more complete overview of the data and digital infrastructure needed to deliver precision medicine at scale is available in a commentary published by Dr. Hooker earlier this year in American Journal of Medical Genetics entitled “Building an infrastructure to enable delivery of genomic medicine.”
About Concert Genetics
Concert Genetics is a software and managed services company that promotes health by providing the digital infrastructure for reliable and efficient management of genetic testing and precision medicine. Concert’s genetic testing management capabilities leverage a proprietary database of the U.S. clinical genetic testing market, market-leading expertise, and a technology platform that supports genetic test ordering, resulting, coding, coverage, and payment integrity. Learn more at www.concertgenetics.com.