Actionable insights begin with deciphering what tests are actually being performed and billed. Concert is uniquely positioned to decode claims because we maintain a proprietary database of the U.S. clinical genetic testing market.
Using sophisticated analytic methods, we match each claim with a specific test (or testing category). Then, we enrich that data with pricing data, policy and laboratory network information, enabling us to provide insight in several key areas:
- Medical Policy – How well do reimbursements align with policies, and where are gaps in policies causing issues?
- Payment Integrity – Where are coding variation, errors, and even gamesmanship by a small number of providers, leading to waste and inefficiency?
- Laboratory Contracting – How do reimbursements align with contracted rates, and where will do contracting opportunities exist?
Concert Genetics has performed this analysis on claims representing over 150 million members for health plans large and small, identifying hundreds of millions of dollars in savings.