Health Plans

Payment Integrity

By integrating claim edits with policy, Concert enables health plans to dramatically improve payment accuracy while removing the burden of manual processes.

Concert’s powerful engine delivers pre-pay claim edits in real time, enforcing payment and medical policy.

Medical Director

Concert removes confusion and frustration from clinical reviews for genetic testing and other advanced diagnostics. Transparent, evidence-based medical policies are clear and easy to apply in clinical review and claim payment workflows. Reference citations support individual criteria sets so clinical reviewers do not have the burden of deciphering which policy reference supports their determination.

Machine-readable criteria automatically enforce what’s covered by health plans in the claim flow, eliminating the need for prior auth in many cases.

Meanwhile, payment policy brings consistency to coding, resolving complex coding for panel tests before these cases arrive for review. The Concert GTU® identifies the exact test, so there is no question about what criteria to apply.  

Finally, Concert’s partnerships let you work with your current systems and vendors for simpler contracting and faster implementation. 

Utilization Management

Concert has transformed the utilization management process for genetic testing and other advanced diagnostics. First, Concert enables prior auth at the test level rather than the code level, eliminating the need to search for which criteria to apply for tests. 

Concert’s coding standards and GTU® test ID bring transparency and consistency to how codes represent tests. From there, clear medical necessity criteria at the test level simplify the review. 

Finally, because Concert enforces a transparent policy with real-time payment accuracy solutions many services can be removed from the prior auth list.  

Network Contracting

Concert’s high-quality partner labs are committed to first-rate standards, billing integrity, and denial reduction from inappropriate claims.

Lab onboarding is simple and easy, with the vast majority of nationwide genetic test volume coming from labs Concert is already working with in conjunction with payer payment policy. Plus, Concert helps onboard additional labs needed.