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Announcing the New and Improved Concert Platform

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The Concert Genetics Benefit Program

A complete solution for health plans from the genetics experts

The Problem

Why focus on genetic testing?

Available Tests
20202012150,00010,000
Codes Per Claim

0

# of codes billed per test
(thousands of code variations)

Medical Policies

0+

Pages of Medical Policies

  • Labor-intensive manual reviews, appeals, denials, and escalations
  • Code-driven waste and confusion
  • Frustrated providers & members

Why dedicate 10-15% of manual reviews and appeals workload to less than 1% of spend?

The Solution

A systematic approach

The Concert Genetics Benefit Program solves the problem upstream, delivering an integrated approach that streamlines day-to-day management efforts

How it Works

The Concert Genetics Benefit Program is a transformative solution built on three key components:

1
Vetted Lab Network

High-quality, high-value labs that commit to quality standards, billing integrity, and reducing denials from inappropriate claims

2
Medical Policy & Rules

Machine-readable medical policies to apply evidence-based standards through rules, and reimbursement policy to establish clear expectations with laboratories

3
Technology Platform

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.

Benefits
Quality

Access and compare laboratory quality, safety, and service information. Direct testing to high-quality, high-value labs.

Efficiency

Reduce administrative burdens associated with prior authorization, claim reviews, denials, and appeals. Standardize coding, reduce waste, and prevent payment errors.

Provider Ease

Improve efficiency and transparency without placing new burdens on providers or members.

Unique Capabilities & Assets

What makes Concert Genetics different?

Technology & Data
Data Platform

Comprehensive registry of genetic tests, organized by a multi-level taxonomy and linked to coverage, coding, and lab quality information

Machine Learning & AI

Proven analytic capabilities, including the ability to decipher multiple codes to identify the genetic test that was actually performed

Claim Editing

Review and correct claims with line-level pre-pay edits, delivered without IT integration costs

Genetics Expertise
Clinical Expertise

Leading experts, working with uniquely comprehensive data, trusted by regional and national health plan customers

Laboratory Relationships

Long track record of collaborating with leading genetic laboratories to enable access to high-quality, high-value testing services

Strategic View of Precision Medicine

Data and capabilities that position health plans to successfully navigate the coming wave of gene therapies and targeted oncology drugs

Health Plans

To learn more about the Genetics Benefit Program…

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Laboratories

To learn more about partnering with Concert…

Complete this form