Concert Genetics leverages its database of genetic tests and health plan claims data to deliver actionable insights and intuitive software solutions.
A Rapidly Growing Field

Genetic testing is one of the fastest growing segments in healthcare. There are more than 65,000 genetic testing products on the market, and 8-10 new tests are added each day. However, fewer than 200 billing codes exist to represent all these genetic tests. So, it is often impossible to tell what test a claim represents. Given these factors, it’s no surprise health plans are struggling to manage genetic testing.

Fortunately, Concert Genetics has a solution to bring order to the chaos.

Claim-to-Test Matching

It starts with deciphering what tests are actually being performed. Concert Genetics is uniquely positioned to decode claims because we have developed and organized the most comprehensive catalogue of genetic tests on the market.

Using sophisticated analytic methods, we run claims through an algorithm that matches each with a test (or testing category) in our database. Then, experts manually review a subset to ensure accuracy.

In matching claims back to the specific product ordered, we answer questions like:

  • Which genetic tests are driving spend?

  • What categories of testing are growing the fastest?

  • What prices are being paid for certain tests?

Concert Genetics has performed this analysis on claims representing over 100 million members for health plans of various sizes, identifying hundreds of millions of dollars in potential savings.

Using these capabilities, we deliver value in three functional areas: Medical Policy, Payment Integrity and Laboratory Contracting.

Medical Policy

After we group claims into clinically relevant test categories, the plan’s medical policies are overlaid on top of the data. This delivers medical policy teams transparency into how the plan’s payments align with their policies – and where gaps exist – either in policy or in enforcement. Then, our team of experts provides guidance on how to resolve any issues.

Payment Integrity

Significant market confusion exists around how to correctly code a genetic test. As a result, claims routinely involve variation, errors – and even gamesmanship by a small number of providers – ultimately leading to considerable waste and inefficiency. By delivering an accurate, up-to-date view of what tests were reimbursed, Concert Genetics is able to surface opportunities to improve payment integrity and ensure more consistent coding.

Laboratory Contracting Support

We help contracting teams understand just how much they’ve paid for specific tests, overlaying the plan’s laboratory contracts and our market pricing data for an enriched view. This process naturally reveals contracting opportunities and areas where current contracts don’t align with actual claims and payments.

What We Offer

Our solutions can be provided in three forms:

  • Data – An enriched claims file with the additional data fields added by Concert Genetics, enabling our clients to run their own analyses.

  • Visualization – Business intelligence that highlights actionable opportunities and benchmarks client information against market-wide data.

  • Consulting – Our genetics experts, empowered by our data and visualization tools, interface with your team on a regular basis to provide world-class insight at the intersection of genetics and coding.

If you believe we can bring value to your health plan, please complete the form on this page and we will reach out to connect.

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