JACKSONVILLE, Fla. and NASHVILLE, Tenn. – Availity^®, the nation’s leading real-time health information network, and Concert^®, the leading provider of clinical content and payment accuracy solutions for advanced diagnostics, have partnered to digitize and automate the prior authorization and payment processes for genetic tests. Together the companies will enable more consistent, transparent, and instantaneous prior authorizations, reducing administrative burden in the delivery of precision medicine.     

With advancements in genetic diagnostics and therapies, providers are better able to personalize patient care. However, genetic testing is an evolving and complex space that is expensive to administer. These tests represent a disproportionately high number of prior authorization clinical reviews, and Utilization Management (UM) teams struggle to keep current with new tests, rapidly evolving clinical guidelines and complex state-level biomarker regulations. These challenges extend to the health plan’s coding and billing functions. Frequently ordered prenatal, oncology, and pharmacogenetic tests are commonly billed with between two and 10 codes. The complexity of these claims means they are more likely to be denied or held for manual review, leading to delay, waste, confusion and frustration for plans, providers and patients.

In an effort to solve these challenges, the companies will integrate Concert’s clinical criteria, coding standards, and Concert GTU® test identifier with Availity’s End-to-End Authorization solution. Doing so will transform manual and error-prone administrative processes into automated authorization recommendations within existing health plan and provider workflows. The goal of this collaboration is that: 

• Providers experience greater consistency and transparency in authorizations, many of which are rendered instantly,
• Health plans benefit from a streamlined prior authorization process, definitive knowledge of the service rendered, and reduced medical director burden surrounding complex authorization and claim reviews, and
• Patients benefit from less delay and uncertainty when their provider is ordering a genetic test, and fewer surprise bills after the fact.

“At Concert, we envision a day when laboratory test reimbursement is determined instantly at the point of patient care. To make this possible, Concert built a flexible data platform for policy and coding that integrates wherever work happens,” said Rob Metcalf, CEO of Concert. “Availity’s information network facilitates healthcare operations across the nation. Concert is delighted to power that network and together enable efficient, evidence-based precision health.”

“At Availity, our goal is to accelerate access to the right care by completely automating critical processes like prior authorization and payment accuracy. Our partnership with Concert represents a critical step forward in this mission by addressing clinically complex conditions, which are among the most time-consuming authorization requests,” said Matt Cunningham, Availity Executive Vice President of Product. “Availity seamlessly integrates Concert’s clinical content within UM workflows and across the care continuum, so health plans and providers have the insights needed to determine and deliver appropriate care, while reducing the wait times that prevent patients from receiving timely access to that care.”  

About Availity
Availity empowers payers and providers to deliver transformative, patient-centered healthcare experiences by enabling the seamless exchange of clinical, administrative, and financial information within established workflows. As the nation’s largest real-time health information network, Availity provides mission-critical connectivity and develops intelligent, automated, and interoperable solutions that foster collaboration and deliver shared value across the healthcare ecosystem through omni-channel connectivity. Availity’s robust, cloud-first technology platform maximizes efficiency, security, and resiliency through responsible use of AI, data-driven insights, extensive partnerships, and a diversified product portfolio. With connections to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, Availity is setting the standards for the future of disciplined healthcare innovation.

For more information about Availity, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn and X.

About Concert
Concert is a healthcare technology company enabling cost-effective access to diagnostics and therapeutics by harmonizing evidence, policy, and payment. Founded in 2010 to bring transparency and efficiency to genetic testing, Concert now offers the definitive precision health payment accuracy platform. The company combines proprietary market data, clinical and coding expertise, and patented technology to support diagnostic test ordering, resulting, coding, coverage, claim editing, and payment integrity. Concert Genetics now operates by its abbreviated name, Concert.

Media Contacts:

Jill Colna / Jill Anderson 
SVM PR, for Availity
401-490-9700 
availity@svmpr.com 

Nick Tazik
SVP Marketing, Concert
ntazik@concert.co
(615) 861-2634

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The full announcement is below. If you would like to learn more about how this can help your health plan more efficiently manage genetic testing, do not hesitate to reach out. If you are a laboratory and want to see the coding standards and GTU for your tests, you can do so with a free account here.

ANNOUNCEMENT

Concert Streamlines Genetic Test Prior Authorizations for Clinicians and Patients

Aligning Concert’s coding standards with EviCore’s clinical guidelines will enable greater automation, fewer peer-to-peer reviews—making precision medicine more accessible

NASHVILLE, Tenn. – With the goal of streamlining patient access to evidence-based genetic testing, Concert will integrate its payment policy, coding standards, and Genetic Testing Unit (GTU®) identifier with EviCore by Evernorth’s medical policies and authorization guidelines. This alignment of clinical and administrative guidelines will enable fewer, simpler authorizations and improve the overall efficiency and transparency of molecular and genomic testing for health plans, providers, and most importantly, patients. This solution will also ensure accuracy in billing and payment processes, creating additional efficiency and minimizing surprise bills for patients.

“The growth and rapidly evolving complexity of genetic testing has led to significant confusion, waste  and administrative burden,” said Rob Metcalf, CEO of Concert. “Together with EviCore, we will bring transparency to the relationship between tests, codes and clinical criteria. In doing so, we will enable clarity, efficiency and consistency for providers so patients can more easily access cost-effective clinically appropriate genetic testing.”

There are more than 175,000 genetic testing products on the market, many of which are represented with multiple codes in highly variable combinations. Some of the most common molecular oncology, prenatal, and pharmacogenomic tests are billed using eight or more codes in thousands of combinations. The confusion caused by this dynamic results in unnecessary and burdensome reviews and peer-to-peer discussions. 

“Genetic testing can unlock tremendous health benefits for patients when used correctly, but the complexity around the selection and billing of tests can prevent that from happening,” said Dr. Lon Castle, Associate Chief Medical Officer, Precision Medicine Services at EviCore. “By simplifying how tests are paid for, we can streamline access to genetic tests for patients, reduce overall costs, and drive down administrative burdens for our provider partners.” 

The combined solution is expected to be available to customers in mid 2024.

About Concert
Concert is a healthcare technology company enabling cost-effective access to diagnostics and therapeutics by harmonizing evidence, policy, and payment. Founded in 2010 to bring transparency and efficiency to genetic testing, Concert now offers the definitive precision health payment accuracy platform. The company combines proprietary market data, clinical and coding expertise, and patented technology to support diagnostic test ordering, resulting, coding, coverage, claim editing, and payment integrity. Concert Genetics now operates by its abbreviated name, Concert. For more information, visit www.concert.co.

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The driving force behind all of these announcements is the same – for years, customers have asked us to apply our transparent, evidence-based approach to policy and payment accuracy to laboratory testing beyond genetic and genomics. In line with our mission to make precision health smart, simple, effective, and affordable, we have now done that. 

To read more, see the links below. If you’d like to learn more please do not hesitate to reach out!

Concert Expands Diagnostic Benefit Program to Manage Laboratory Testing for Health Plans

Expanded solution, clinical advisory board, and new website set a path to bring transparency and efficiency to a growing set of health services…

Concert Announces Clinical Advisory Board, New Medical Policies

Drs. Beth Harris, Thomas Holland, Girish Putcha, and Michele Schoonmaker join board to advise Concert on clinical policy content…

Lyric and Concert Expand Partnership to Deliver Laboratory Payment Accuracy Solution

The Diagnostics Module—available through Lyric’s expanded partnership with Concert—will seamlessly deliver Concert’s integrated policy and payment accuracy capabilities for a growing scope of laboratory testing

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NASHVILLE, Tenn. (May 1, 2024) – Concert has expanded its Diagnostic Benefit Program, formerly known as the Genetics Benefit Program, to provide payment and clinical policies and payment accuracy capabilities across routine and advanced laboratory testing, enabling health plans to provide their members with access to these important clinical services at lower total costs, the company announced today. 

“Diagnostics are critical in the delivery of effective, personalized care. Unfortunately, ambiguity in the coverage, coding, and reimbursement leads to waste and confusion as providers, laboratories, and health plans work together to serve patients,” said Rob Metcalf, CEO of Concert. 

Laboratory testing has become complex and costly to manage, as new tests, evidence, clinical guidelines, and codes emerge rapidly. This quarter, almost 60 applications for Proprietary Laboratory Analyses (PLA) codes are under consideration.¹ Meanwhile, frequently ordered molecular oncology, pharmacogenetic and infectious disease tests are commonly billed with more than 10 codes,² often obscuring the test that was performed. As a result of the rapid changes underway, many health plans’ policy and coding configurations lag behind the market, and payment errors are common. 

The Diagnostic Benefit Program provides transparent, evidence-based policies, a synchronized library of claim edits, and technical integration capabilities that can deliver this content through the customer’s preferred clinical decision support and claims editing platforms. Together these enable plans to improve transparency, reduce administrative burden and achieve cost savings, all while keeping pace with the rapidly evolving market. 

In a separate release, Concert announced the formation of a clinical advisory board, which will advise Concert on its expanding set of clinical policy content. Advisors include Drs. Beth Harris, Thomas Holland, Girish Putcha, and Michele Schoonmaker.

“Expanding our clinical content, and the expertise that supports its development, means Concert can bring transparency, efficiency, and accurate reimbursement to more areas of care,” said Gillian Hooker, Concert’s Chief Scientific Officer. “Our goal is to deliver clarity of coverage and costs all the way to the point of care, and today’s announcements represent important progress towards that goal.”

More information about the Diagnostic Benefit Program and the clinical advisory board can be found at Concert’s new website at www.concert.co. With today’s announcement, Concert Genetics will now operate by its abbreviated name, Concert, which many customers and partners have used for years to refer to the company.

About Concert

Concert is a healthcare technology company enabling cost-effective access to diagnostics and therapeutics by harmonizing evidence, policy, and payment. Founded in 2010 to bring transparency and efficiency to genetic testing, Concert now offers the definitive precision health payment accuracy platform. The company combines proprietary market data, clinical and coding expertise, and patented technology to support diagnostic test ordering, resulting, coding, coverage, claim editing, and payment integrity. For more information, visit www.concert.co.

¹ For more information on CPT® PLA codes visit: https://www.ama-assn.org/practice-management/cpt/cpt-pla-codes. CPT® is a registered trademark of the American Medical Association.

² Concert Data

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NASHVILLE, Tenn. (May 1, 2024) – As part of its commitment to provide transparent, evidence-based medical policy and enable accurate reimbursement for a broader set of diagnostic services, Concert today announced the establishment of an advisory board of experts in clinical laboratory medicine and the release of policies for an expanded scope of routine and advanced laboratory testing. 

The newly formed board will advise Concert on its clinical laboratory content. Members include Drs. Beth Harris, Thomas Holland, Girish Putcha, and Michele Schoonmaker. Details on each board member appear below. 

“Expanding the expertise that informs our content means Concert can bring transparency and efficiency to a broader set of health services, while keeping our solutions tightly linked to the latest evidence and guidelines,” said Gillian Hooker, Concert’s Chief Scientific Officer. “We are thrilled Drs. Harris, Holland, Putcha, and Schoonmaker have decided to join us in this effort.”

In a separate release, Concert announced the expansion of the Diagnostic Benefit Program, formerly known as the Genetics Benefit Program, which now provides policies and payment accuracy capabilities across routine and advanced laboratory testing, enabling health plans to provide their members with access to these important clinical services at lower total costs, the company announced today.

“Concert is working to align payers, providers, and labs to enable patient access to evidence-based testing,” said Dr. Girish Putcha. “They have a comprehensive view of the industry so they can create transparent, scalable, and holistic solutions to structural problems in coding, coverage, and reimbursement that hinder precision medicine. I am excited to join this board to guide and support that work.” 

Following are brief bios on each member of the new clinical advisory board, in alphabetical order by last name. More information can be found at Concert’s new website at www.concert.co. With today’s announcement, Concert Genetics will now operate by its abbreviated name, Concert, which many customers and partners have used for years to refer to the company.

Beth Harris, MD

Dr. Harris is a gastrointestinal/hepatobiliary pathologist with extensive experience in both clinical practice and managed care. She served as a Medical Director at Humana and practiced as a gastrointestinal/hepatobiliary and surgical pathologist for PathGroup in Nashville, Tenn., and Associated Pathologists of Albuquerque in New Mexico. Today, she is a practicing pathologist at Covenant Physician Partners and an Assistant Professor of Pathology, Microbiology and Immunology at Vanderbilt University Medical Center. Dr. Harris completed her Bachelor of Science in Molecular Biophysics and Biochemistry at Yale University and her MD at University of Maryland School of Medicine. She completed her residency in anatomic pathology at Emory School of Medicine, and her fellowship in gastrointestinal/hepatobiliary at Vanderbilt. 

Thomas Holland, MD, MSc-GH

Dr. Holland is an Associate Professor of Medicine, Division of Infectious Diseases, at Duke University, where he practices both as a hospitalist and infectious disease specialist. He has expertise in conducting multidisciplinary research in antimicrobial resistance, particularly in the design and conduct of clinical trials in Staphylococcus aureus infections. He additionally led the clinical response to the COVID pandemic at Duke Health, where he directed dedicated COVID wards, cared for patients, kept clinical teams up-to-date on rapidly evolving scientific and treatment information, and conducted clinical trials. He was awarded the Presidential Award for his efforts. A physician scientist with a deep interest in global health, Dr. Holland’s work overseas has included investigating the prevalence of rheumatic heart disease in Kenya and working with a primarily Aboriginal population in the Australian Outback. Dr. Holland received his undergraduate degree from Princeton University in Ecology & Evolutionary Biology and his MD from Wake Forest University. He completed Internal Medicine residency and Infectious Diseases fellowship training at Duke, where he currently practices. 

Girish Putcha, MD, PhD

Dr. Putcha is a molecular pathologist with extensive experience in academia, industry, the investment community, and payer coverage and reimbursement for molecular diagnostic tests. Recent roles include Director of Laboratory Science at Palmetto’s MolDX program, Chief Medical Officer and Clinical Laboratory Director of Freenome, and Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) member. Today, he is an independent advisor at Precision Medicine & Diagnostics LLC. Dr. Putcha earned his undergraduate degree in biochemistry, medical ethics, and health policy from Rice University and his MD/PhD in neuroscience from Washington University in St. Louis. He completed his residency in clinical pathology and fellowship in molecular genetic pathology at Stanford University School of Medicine, where he also served as adjunct faculty. 

Michele Schoonmaker, PhD 

Dr. Schoonmaker is a recognized expert in public policy and government affairs in the laboratory market. She spent 17 years with Cepheid, a leading molecular diagnostics company, where her primary responsibilities were to develop and implement global strategic reimbursement plans for Cepheid’s molecular diagnostic product. Prior, Dr. Schoonmaker worked for the U.S. Food and Drug Administration (FDA) as a regulatory policy analyst and reviewer of diagnostic tests, and she was a Specialist in Genetics for the Congressional Research Service (CRS), a division of the Library of Congress. Dr. Schoonmaker earned her undergraduate degree in molecular biology from Goucher College and her PhD in health services research, genetics and public policy from Johns Hopkins University School of Hygiene and Public Health.

About Concert

Concert is a healthcare technology company enabling cost-effective access to diagnostics and therapeutics by harmonizing evidence, policy, and payment. Founded in 2010 to bring transparency and efficiency to genetic testing, Concert now offers the definitive precision health payment accuracy platform. The company combines proprietary market data, clinical and coding expertise, and patented technology to support diagnostic test ordering, resulting, coding, coverage, claim editing, and payment integrity. Concert Genetics now operates by its abbreviated name, Concert. For more information, visit www.concert.co.

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Lyric, an AI-first leader in payment accuracy, has expanded its partnership with Concert to deliver payment accuracy across a rapidly expanding set of advanced and routine laboratory tests, the companies announced today. 

The Diagnostics Module, formerly known as the Genetic Testing Module, will expand to address outpatient infectious disease testing, which has become the largest area of outpatient lab spend for many health plans, due to the increases in testing during the COVID-19 pandemic. Together, Concert and Lyric will deliver a technology solution for laboratory payment accuracy that is transparent, reduces the chance for errors, and is minimally abrasive.  

“Managing the growth and complexity of laboratory testing is a top priority for many of our health plan customers,” said Lyric CEO Rajeev Ronanki. “Combining Lyric’s market-leading payment accuracy capabilities with Concert’s data, clinical policies, and AI-powered edits will deliver unparalleled accuracy for our customers and aligns with our strategy to bring best-in-class partner solutions to customers via Lyric’s technology.” 

The solution will deliver Concert’s claim editing—based on its integrated payment policy and medical policy content—through a seamless customer experience. The companies expect to continue to expand this solution to a broadening set of laboratory testing, delivering a level of transparency and accuracy not available from others on the market. 

“Concert is rapidly deploying solutions to enable transparency, efficiency, and value in precision health services, including diagnostics and therapeutics,” said Concert CEO Rob Metcalf. “Partnering with Lyric makes these solutions available to customers where they want them, in a solution they use and trust, with minimal implementation and maintenance effort required. The ultimate beneficiary is the health consumer who can access precision healthcare at lower costs.” 

Lyric and Concert first partnered in 2023 to deliver an integrated genetic test management solution. The expanded Diagnostics Module is expected to be available to customers in summer 2024. 

About Lyric: 

Lyric is a leading AI-first healthcare technology company, committed to simplifying the business of care. Over 35 years of experience, dedicated teams, and top technology help deliver more than $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric’s solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric’s strong relationships as a trusted ally to customers resulted in recognition from KLAS as “true partner” and “excellent value for investment,” with a top score for overall customer satisfaction and A+ likelihood to recommend in their October 2023 Payment Integrity and Accuracy Report. Discover more at Lyric.ai.  

About Concert

Concert is a healthcare technology company enabling cost-effective access to diagnostics and therapeutics by harmonizing evidence, policy, and payment. Founded in 2010 to bring transparency and efficiency to genetic testing, Concert now offers the definitive precision health payment accuracy platform. The company combines proprietary market data, clinical and coding expertise, and patented technology to support diagnostic test ordering, resulting, coding, coverage, claim editing, and payment integrity. Concert Genetics now operates by its abbreviated name, Concert. For more information, visit www.concert.co. 

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This solution addresses a costly challenge for health plans, and for the members they serve. Genetic testing claims are often complex and confusing, making them administratively difficult to process. Manual efforts to process these claims lead to inconsistent results that impact patient access and overall costs.

Automating accurate reimbursement for genetic tests is on the critical path to implementing cost-effective precision medicine in the U.S. healthcare system. Today’s announcement is an important step on this path, and as such, we are pleased to share it. The full announcement is below, and more information is available at the Lyric website.

June 7, 2023 – Lyric, formerly ClaimsXten Portfolio, has partnered with Concert Genetics (Concert), a leader in end-to-end genetic testing management, to deliver solutions to health plan payers who seek to maximize payment accuracy for genetic testing claims.

“Our partnership will combine machine learning models and proprietary market data,” Lyric CEO Rajeev Ronanki said. “By bringing together the power of our market-leading editing solution with Concert’s market-leading end-to-end genetic testing edits, we’re eliminating complexity in the ever-changing genetic testing space.”

Adding genetic testing content to Lyric’s payment accuracy offering will help to address a costly challenge for health plans and their members, as consistent payment decisions are almost impossible to achieve when frequently ordered genetic tests are billed using numerous codes in potentially thousands of combinations. The number of tests, scope of clinical applications, and associated clinical evidence are increasing, which can be challenging for healthcare providers and insurers. As a result, the experience of payers, providers, and patients is often fragmented and frustrating, potentially limiting access to clinically appropriate testing.

“This partnership is just one example of Lyric’s vision to simplify the business of care. We will continue to expand our own expertise and innovation, while also creating strategic partnerships with other industry leading subject matter experts to bring additional value to our customers, while reducing speed to market. The resulting solution will be a comprehensive playlist of options that will best meet our customers’ specialized needs,” Ronanki explained.

“Concert Genetics is building towards a vision in which information on genetic testing, including coverage and cost, is instantly available at the point-of-care to support informed clinical decisions and cost-effective access for patients,” said Rob Metcalf, CEO of Concert Genetics. “We are delighted to partner with Lyric, an organization that is aligned with this vision and brings to bear the technical infrastructure to connect information all the way through to reimbursement decisions.”

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About Lyric
Healthcare is complex. When codes, transactions, and small intricacies can lead to large issues and costly errors, transparency is more important than ever.

Lyric combines a flexible software rules engine with a comprehensive library of clinical content to help health plans address policy management needs and pay claims correctly the first time. The company’s advanced editing framework effectively applies health plan, governmental, and industry policy to a claim in near real time with interoperability designed and built to scale with a plan’s mix of products, network infrastructure, and growth. Lyric’s comprehensive product suite includes primary and secondary editing, content and policy management, and other analytics services and solutions.

If the healthcare tech system is a song, then clarity and seamlessness are its lyrics. We’re changing the tune of transparency by simplifying the business of care. Visit us at: www.lyrichealth.com to learn more about us.

About Concert Genetics
Concert Genetics is a software and managed services company that promotes health by providing the digital infrastructure for reliable and efficient management of genetic testing and precision medicine. Concert’s genetic testing management capabilities leverage a proprietary database of the U.S. clinical genetic testing market, market-leading expertise, and a technology platform that supports genetic test ordering, resulting, coding, coverage, and payment integrity.

The post Concert and Lyric Partner to Deliver Genetic Test Payment Accuracy in ClaimsXten appeared first on Concert.

“For too long, systemic barriers, such as confusing, conflicting, or inconclusive medical policies, have stood in the way of patients receiving cost-effective, medically necessary testing,” said Gillian Hooker, PhD, ScM, LCGC, Chief Scientific Officer of Concert Genetics. “Concert is overcoming those barriers by offering medical policies that are transparent, up-to-date with the rapidly changing market and evidence, and available for all to view.”

The newly published medical policies span a wide scope of clinical areas, including prenatal, hereditary cancer, oncology, pharmacogenetic, system-specific disorders (e.g., cardiology, neurology), pediatric, and rare disease. Policies are available to view in their entirety, and users can provide feedback directly from the platform. In addition, as the market changes and evidence evolves, the platform dynamically updates relationships between tests and criteria, so users can always find the current criteria for a given test. This is especially important as new tests are added to the catalog at a rate of more than 30 per day.

This application builds on capabilities recently announced by Concert, including the GTU test ID system, the Concert Coding Engine, and a patented ability to digitize medical policies for automation in coverage determination and payment accuracy.

“While the version released today displays only Concert’s reference policies, not those of any specific health plan, the application demonstrates how coverage determination can be clear and nearly instantaneous for all stakeholders, shortening the path to clinically appropriate care and coverage,” said Hooker.

Concert’s newly added reference policies can be accessed by creating an account at: https://app.concertgenetics.com/apps/policies

Health plans looking to learn more about Concert’s genetic testing management program for health plans: https://www.concertgenetics.com/genetics-benefit-program/

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About Concert Genetics
Concert Genetics is a software and managed services company that promotes health by providing the digital infrastructure for reliable and efficient management of genetic testing and precision medicine. Concert’s genetic testing management capabilities leverage a proprietary database of the U.S. clinical genetic testing market, market-leading expertise, and a technology platform that supports genetic test ordering, resulting, coding, coverage, and payment integrity. Learn more at www.concertgenetics.com.

The post Concert Genetics Publishes Complete Genetic Testing Reference Policies Integrated with Open, Searchable Test Catalog appeared first on Concert.

NASHVILLE, Tenn. (Aug 26, 2021) – Concert Genetics has launched a genetic testing payment accuracy and compliance solution for Medicare and Medicare Advantage plans. The offering extends Concert’s innovative solution for commercial plans, providing unparalleled test identification, coding consistency, and automated determination of coverage to address both compliance and cost of care needs.

Payment accuracy in genetic testing is an urgent issue. In Medicare Fee For Service (FFS), which represents nearly 60% of the total Medicare beneficiary population, spending on genetic tests grew 47% annually from $289 million in 2015 to $1.36 billion in 2019, offsetting any reduction in laboratory spending expected to result from the Protecting Access to Medicare Act (PAMA), according to the U.S. Department of Health and Human Services Office of Inspector General. Meanwhile, the U.S. Department of Justice revealed more than $2.1 billion in losses due to fraudulent genetic testing billing, which it called “one of the largest health care fraud schemes ever charged.”

In addition to the cost of payment errors, complexity in genetic testing increases administrative expense and raises compliance risks. Research from Concert Genetics has shown multi-gene tests are often billed using 10 or more codes in thousands of combinations. With hundreds of genetics laboratories distributed across the country, Medicare Advantage plans must also contend with different coverage, coding, and billing guidance based on the Medicare Administrative Contractor (MAC) jurisdiction of the rendering laboratory.

“Genetic testing management is costly and administratively burdensome for Medicare plan administrators, and the cost is ultimately borne by the taxpayers they represent,” said Rob Metcalf, CEO of Concert Genetics. “By identifying specific tests, applying coding standards, and enforcing jurisdiction-specific coverage criteria, all in real time, Concert can deliver significant value to health plans and to the healthcare ecosystem.”

Concert’s Medicare solution leverages a unique combination of assets and capabilities that include:

• Genetic Testing Units (GTU), the market’s only comprehensive unique ID system for all 160,000 tests;
• Patented systems and methods to convert national coverage determinations (NCDs), local coverage determinations (LCDs), and billing and coding articles into data structures for automated enforcement; and
• Technology infrastructure that delivers real-time connectivity for pre- and post-payment review.

The solution is built and supported by a team of clinical genetics experts, data scientists, and software engineers. Concert’s Medicare solution is currently in beta with initial customers and will be generally available in early 2022.

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About Concert Genetics
Concert Genetics is a software and managed services company that promotes health by providing the digital infrastructure for reliable and efficient management of genetic testing and precision medicine. Concert’s genetic testing management capabilities leverage a proprietary database of the U.S. clinical genetic testing market, market-leading expertise, and a technology platform that supports genetic test ordering, resulting, coding, coverage, and payment integrity.

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NASHVILLE, Tenn. (June 24, 2021) – Concert Genetics has released its comprehensive genetic test identification system for use in the market, enabling a level of automation in test ordering, coverage, payment and clinical decision support never before possible, the company announced today.

Concert’s Genetic Testing Units (GTUs) are the first and only ID system that uniquely identifies all 160,000 genetic testing products, organizes them into a multi-level taxonomy, and incorporates new tests as they enter the market, which is currently happening at a rate of more than 30 per day. Initially developed as an internal test tracking system, Concert’s GTUs have powered the company’s widely used, end-to-end genetic test management solutions, becoming essential infrastructure for precision medicine in the process. Today, they become available to the market at a time when the need for reliable test identification is more urgent than ever.

Ambiguity in test identification has created unsustainable burdens for healthcare stakeholders. For example, disagreements between health plans and laboratories about test reimbursement often arise from the codes used to bill the test. Genetic tests are billed using an average of 6.9 codes, often in thousands of code combinations (source). The inevitable confusion leads to a protracted series of denials and appeals that waste valuable clinical resources and distract from patient care.

“At Concert, we believe in the promise of precision medicine, and we recognize this promise will not become a reality until unnecessary friction is eliminated,” said Rob Metcalf, CEO of Concert Genetics. “Today, every system of record in healthcare, from electronic medical records and lab information systems to billing and claims payment systems, operates with a different or incomplete language to identify tests. Without a common language, automated digital communication has been impossible, and manual work has been the only option. As of today, that is no longer the case.”

Concert’s GTU system assigns a five-digit alphanumeric code to each specific, orderable test from a specific lab. The system links to Concert’s master test catalog and covers a wide range of clinical areas, including prenatal, pediatric, rare disease, pharmacogenomic, hereditary cancer, and somatic oncology tests. The system is organized into Concert’s multi-level taxonomy, which groups the 160,000 individual testing products into almost 45,000 categories, which roll up into 34 domains and 8 clinical areas.

In the context of Concert’s data platform, the test identification system also ties with other key data assets, including billing codes, lab quality information, and health plan medical coverage policies, enabling automation where manual work is otherwise required. This system builds on Concert’s recently announced patent US10,896,405, for capabilities that support real-time, automated coverage determination and accurate reimbursement of genetic tests.

“The reason this system is transformative is that it eliminates manual work and potential for error at every step in the value chain,” said Metcalf. “A test can be selected, authorized, ordered, resulted, billed, adjudicated, and correctly paid through a seamless exchange of information between systems that requires few if any manual stops, all because of unanimous agreement about the test in question.”

“The promise of precision medicine lives on the other side of that transformation, first because it tightens the link between tests, care pathways, and targeted therapies, and second, because it supports a true learning system,” said Gillian Hooker, PhD, ScM, LCGC, Concert’s Chief Scientific Officer. “With test-specific identification, real-world outcomes studies and economic value analysis based on observational data are finally within reach.”

Concert GTUs can be accessed and viewed on the Concert website, and are available on a royalty-free basis under the terms and conditions for many uses. Licenses for additional uses, including derivative works, can be obtained from Concert. The easiest way to view Concert GTUs and the terms and conditions of their use is by creating a free account here.

More information about the technical and design aspects of the GTU system are documented in a whitepaper, which can be downloaded here.

For more information about this announcement, or to inquire licensing options for Concert GTUs, contact us.

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About Concert Genetics
Concert Genetics is a software and managed services company that promotes health by providing the digital infrastructure for reliable and efficient management of genetic testing and precision medicine. Concert’s genetic testing management capabilities leverage a proprietary database of the U.S. clinical genetic testing market, market-leading expertise, and a technology platform that supports genetic test ordering, resulting, coding, coverage, and payment integrity. Learn more at www.concertgenetics.com.

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