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., May 21, 2024
/PRNewswire/ -- 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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SOURCE Concert