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., 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.

SOURCE Concert