Definitive Guide to Genetic Testing for Health Plans (Part II)

The Solution:
Unify UM, claims & network management for an end-to-end genetic testing solution.

This whitepaper is Part II of a 2-part series. Part I, which focuses on the challenges in genetic testing and requirements for an effective solution, is available here

Genetic testing has been in clinical use for more than 20 years, yet most health plans continue to experience unnecessary waste and administrative burden associated with it. This is true even for plans that have a vendor (or multiple) engaged to manage it. This is because prevailing solutions do not address the fundamental challenges presented by genetic testing.

The Concert Genetic Benefit Program solves the fundamental challenges in genetic testing management, providing test identification, coding standards, evidence-based coverage criteria, pricing data, and payment accuracy capabilities, all integrated on a common data platform for efficient implementation. The program has clinical, operational & financial benefits that improve performance and yield measurable results.

This whitepaper provides a deeper look into the components of the Concert program and how they generate value for the health plan. These include:

Network management
Payment Policy
Market-Based Fee Schedule
Lab Contracting Support
Preferred Lab Program

Medical Management
Medical Policy
Utilization Management/Prior Authorization Support

Claims & Payment Integrity
Post-pay analytics
Pre-pay claim edits

In addition, Case Studies of successful health plan customers detail the clinical, operational, and financial benefits of the Concert program.

To access the whitepaper instantly, complete the form on this page.

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