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Announcing the New and Improved Concert Platform
Continue to Concert Genetics Website
A complete solution for health plans from the genetics experts
Why focus on genetic testing?
# of codes billed per test
(thousands of code variations)
Pages of Medical Policies
Why dedicate 10-15% of manual reviews and appeals workload to less than 1% of spend?
A systematic approach
The Concert Genetics Benefit Program solves the problem upstream, delivering an integrated approach that streamlines day-to-day management efforts
The Concert Genetics Benefit Program is a transformative solution built on three key components:
High-quality, high-value labs that commit to quality standards, billing integrity, and reducing denials from inappropriate claims
Machine-readable medical policies to apply evidence-based standards through rules, and reimbursement policy to establish clear expectations with laboratories
A one-of-a-kind, comprehensive platform that links all genetic tests with policies, codes, and prices, enabling claim edits and other automation
Together, these form an integrated program that reduces or eliminates the need for labor-intensive prior authorization and manual claim review.
Access and compare laboratory quality, safety, and service information. Direct testing to high-quality, high-value labs.
Reduce administrative burdens associated with prior authorization, claim reviews, denials, and appeals. Standardize coding, reduce waste, and prevent payment errors.
Improve efficiency and transparency without placing new burdens on providers or members.
What makes Concert Genetics different?
Comprehensive registry of genetic tests, organized by a multi-level taxonomy and linked to coverage, coding, and lab quality information
Proven analytic capabilities, including the ability to decipher multiple codes to identify the genetic test that was actually performed
Review and correct claims with line-level pre-pay edits, delivered without IT integration costs
Leading experts, working with uniquely comprehensive data, trusted by regional and national health plan customers
Long track record of collaborating with leading genetic laboratories to enable access to high-quality, high-value testing services
Data and capabilities that position health plans to successfully navigate the coming wave of gene therapies and targeted oncology drugs