Concert Genetics Unveils End-to-End Genetic Testing Management Program for Health Plans

Concert Genetics Benefit Program Combines Policy, Payment Integrity, and a Preferred Laboratory Network to Improve Quality, Reduce Complexity, and Eliminate Manual Effort

Concert Genetics unveiled the Concert Genetics Benefit Program, an end-to-end genetic testing management solution that enables health plans to provide members with access to high-quality, clinically appropriate genetic testing while improving payment integrity and reducing manual work.

This solution comes as the volume of genetic testing continues to rise, and as biomarkers increasingly influence clinical decisions, quality and cost of care. The unique challenges of genetic testing – rapidly innovating products, complex underlying technologies and highly variable codes – create confusion in coverage, time-consuming reviews, inconsistent decisions, and frequent appeals.

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“We saw an unsustainable rise in the administrative cost of managing genetic testing – for both plans and laboratories – so we built a solution to radically simplify and streamline these burdensome efforts by enabling greater clarity at every step in the process,” said Rob Metcalf, CEO of Concert Genetics.

Key components of the program are as follows:

• Test Registry: Comprehensive registry of the U.S. clinical genetic testing market, which includes more than 150,000 unique testing products, and software that collects genetic laboratory quality information and provides an authoritative mapping of each laboratory test catalog to the corresponding health plan medical policy, b****** codes, and rate.
• Coding Engine: Product that systematically assigns a b****** code or combination of codes to each test in the registry, bringing transparency and consistency to an otherwise highly variable process.^1,2
• Medical Policies: A complete set of medical policies written by clinical genetics experts for clarity and ease of interpretation. Each test in the registry is linked to a medical policy via a comprehensive taxonomy.
• Real-Time Claim Edits: Machine learning and artificial intelligence capabilities identify the test performed, even for multi-gene panel tests represented by complex multi-code combinations. Cloud-based technology applies policy and corrects claims with line-level edits on a pre-pay basis.
• Preferred Laboratory Network: Vetted network of high-quality laboratories that have committed to quality standards, b****** integrity, and reducing denials from inappropriate claims.

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“No other vendor can provide a solution that delivers quality, efficiency and transparency, while reducing manual effort,” said Metcalf. “With the Concert Genetics Benefit Program, health plans can provide members with access to high-value precision medicine services and improve the experience for everyone along the way.”

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