Companies Provide Pre-payment Solution to Improve Coding and Billing Accuracy
BEDMINSTER, NJ and NASHVILLE, TN – September 24, 2020 – Zelis, the healthcare industry’s leading claims cost and payments optimization platform with superior technology and solutions to price, pay and explain claims, and Concert Genetics, a technology company dedicated to advancing precision medicine, have launched a claim editing solution for the complex and rapidly-growing area of genetic testing.
The solution embeds Concert’s claim editing capabilities, which are powered by robust genetic testing market data and machine learning, into Zelis’ existing claim editing platform. This leading-edge platform already contains more than 18 million edits sourced to national coding standards. The partnership adds specialized content in genetic testing that other platforms lack, enabling Zelis and Concert to improve coding and billing accuracy of these complex and ambiguous genetic test claims before they are paid.
“Our clients are experiencing higher costs due to the complexity of managing the variability of genetic testing codes and volume of new tests entering the market,” said R. Andrew Eckert, Zelis CEO. “Combining our payment integrity expertise with Concert’s precision technology will enable us to proactively identify inaccurate claims and continue to support our clients with innovative solutions to reduce costs.”
This solution comes at a critical time, as the availability and demand for genetic tests grow with the global genetic testing market expected to reach $17.6 billion by 2025, from $7.5 billion in 2017.(1) Additionally, the total number of available genetic testing products has surpassed 150,000, up from around 10,000 in 2012. Meanwhile, much of the growth in volume is represented by multi-gene panel tests, which are particularly difficult for health plans to process in an efficient and accurate way because they are billed using multiple billing codes in widely varying combinations. Some categories of genetic tests are billed in thousands of different code combinations.
“The pace of advancement in the science and clinical application of genetics is remarkable, and the healthcare system has had difficulty keeping up,” said Rob Metcalf, CEO of Concert Genetics. “Concert has assembled the data and digital infrastructure to enable transparency, connectivity, and value in this space, and we are pleased to partner with Zelis to make our technology available to its clients.”
A key enabler of this claim editing solution is its ability to match complex claims with multiple billing codes back to its catalog of tests on the market. The combined solution is available to Zelis clients effective immediately.
(1) Allied Market Research report, Genetic Testing Market by Type (Predictive Testing, Carrier Testing, Prenatal & Newborn Testing, Diagnostic Testing, Pharmacogenomic Testing, and Others), Technology (Cytogenetic Testing, Biochemical Testing, and Molecular Testing), and Application (Chromosome Analysis, Genetic Disease Diagnosis, Cardiovascular Disease Diagnosis, and Others): Global Opportunity Analysis and Industry Forecast, 2018–2025
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Zelis is the healthcare industry’s leading claims cost and payments optimization platform with superior technology and solutions to price claims, pay claims and explain claims, all at enterprise scale on a claim-by-claim basis. Zelis leverages proprietary technology, robust analytics, extensive payment and provider networks, and innovative claim savings channels to deliver to the industry superior administrative and medical cost savings. Zelis was founded on a belief that there is a “better way” to determine the cost of a healthcare claim, manage payment related data, and make the claim payment. Zelis provides the industry’s only comprehensive, integrated platform to take a claim through the entire pre-payment to payments lifecycle. Zelis’ ~1000 associates serve more than 700 payor clients, including the top-5 national health plans, Blues plans, regional health plans, TPAs and self-insured employers, and more than 1.5 million providers. Zelis delivers more than $5B of claims savings, $50B of provider payments and 500 million payment data communications annually.
About Concert Genetics
Concert Genetics is a software and managed services company that advances precision medicine by providing the digital infrastructure for reliable and efficient management of genetic testing. Concert’s market-leading genetic test order management platform leverages a proprietary database of the U.S. clinical genetic testing market – today more than 150,000 testing products – and genetic testing claims from more than 100 million lives. Learn more at www.concertgenetics.com.