Payment Accuracy

Concert delivers claims payment accuracy in real-time based on medical and payment policy, which enables dramatic savings, simplifies the complex area of genetic testing, and brings transparency to general lab testing.

We digitally integrate guidelines, policy, coding, and claim edits on one flexible technology platform that delivers real-time pre-payment instructions directly into the health plan’s platform of choice. 

No other vendor offers machine-readable policy and machine learning-powered claim editing for real-time automation that health plans trust. 

Claim Edits

Concert delivers unparalleled pre-pay claim editing through your preferred editor by uniquely integrating machine-learning-powered test identification and rich, machine-readable clinical content and coding standards. 

With evidence- and guideline-based policies integrated into claim edits, we automate accurate test reimbursement, reducing or eliminating the need for manual review.

  • Unparalleled edit accuracy
  • Clear evidence-based policy
  • No need for a new claim feed

Payment Policy & Edits

Concert brings consistency to coding for advanced diagnostics. Simplify clinical reviews and claims processing with less administrative burden and lower medical costs. Concert’s payment policy requires labs to adhere to Concert’s coding standards and supports the use of the GTU on genetic testing claims. 

Benefit from fewer codes per claim, easier clinical reviews, and automated claim editing to enforce coding.

  • One policy for all labs and tests in scope
  • Coding standards for each genetic test
  • Claim edits ensure accuracy before claims are paid

Medical Policy & Edits

Concert provides medical policy edits using the patented3 ability to digitize clinical criteria and embed it into claim editing logic. Providers have transparent access to medical policies for greater clarity and less abrasion. Edits ensure claim payment is consistent with policy.

This unique capability has enabled health plans to reduce prior authorization by 50-70% in genetic testing while simultaneously lowering medical costs.

  • Clear, transparent clinical criteria 
  • Low abrasion and appeals
  • Reduced need for prior authorization

Get Started

We keep implementation simple. Fill out the form if you’re ready to put Concert’s Payment Accuracy into motion. Our team will be in touch soon.

Welcome to the new Concert website! See what else is new: