Medical Policy

Access clear and user-friendly clinical criteria built for payment accuracy on the back end.

Guideline & Evidence-Based Approach

Concert’s medical policies are — first and foremost — guideline-based. Policies are updated semi-annually to keep pace with guidelines in rapidly evolving specialties like oncology. 

Where guidelines do not exist, Concert performs evidence review to ensure criteria is consistent with the latest reliable evidence.  

Finally, because Concert manages reference support for individual criteria sets, clinical reviewers do not have the burden of deciphering which policy reference supports their determination. 

  • Updated 2x/year 
  • Tracks guidelines and emerging evidence
  • References listed for each set of criteria

Criteria Built for Automation

Concert provides evidence-based medical policy using its patented ability to digitize clinical criteria, making it possible to embed policy logic into clinical decision support, payment accuracy, and prior authorization automation solutions. Concert’s policies enable more efficient clinical review for clinical staff, and they also align with claims systems to ensure accurate payment consistent with policy.

Depending on the customer’s preference, Concert will provide policy documents for adoption, integrate criteria into the CDS platform of choice, and/or deliver payment accuracy solutions based on policy content.

  • Designed to streamline clinical review
  • Digitized for auto-authorization and claim editing
  • Available from Concert or within your preferred platform

Connect With Concert

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