Amidst the rapid growth in the genetic testing market, one persistent challenge has been ambiguity and inconsistency in how genetic test claims are coded. Variation in coding leads to administrative burden, error, waste.

Concert developed a novel solution in 2019 – the Concert Coding Engine – which translates each genetic test into a single code or code combination. Since the launch of this solution, many health plans have instituted requirements for labs to code according to the Concert coding standards for reimbursement, leading to outcomes that benefit plans, labs, and most importantly, health consumers.

This paper describes the Coding Engine, including the guiding principles, data inputs, underlying logic, and results of implementation.

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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.

The post Definitive Guide to Genetic Testing for Health Plans (Part II) appeared first on Concert.

The science of genetics has unlocked exciting advancements in health and life sciences. Unfortunately, the complexity of genetic testing creates confusion, burden, and waste for health insurers. Traditional solutions have failed to adequately address these challenges.

This whitepaper provides a comprehensive look at the problem and delivers actionable enterprise and department-level recommendations to put in place an end-to-end solution.

Content includes:

• 3 fundamental challenges that prevent health plans from effectively managing genetic testing
• Department-level deep-dives in:

Medical Policy
Medical Management & UM
Claims Operations
Payment Integrity
Network Contracting
Genetics / Genomics
Finance
Medical Economics
Member Services & Members

• Requirements for an effective solution with actionable recommendations at the enterprise and department levels
• Comprehensive challenge-solution grid
• RFP Checklist for evaluating potential vendors
• Other valuable resources including program scope outlines and reference medical policies

For instant access to the document, complete the form on this page.

The post Definitive Guide to Genetic Testing for Health Plans (Part I) appeared first on Concert.

One significant challenge is communication between parties about specific genetic tests. Concert Genetics is addressing this problem by making its unique test identifier, the Concert GTU (genetic testing unit), available to the industry. For years, the GTU has played an essential role in enabling Concert to track and organize the industry’s genetic tests. Because ambiguity in test identification remains a persistent challenge for the healthcare system, Concert’s proven method for test identification has broad utility and value. 

This paper describes the GTU system in greater detail, including:

• Objectives of the GTU test identification system

• Guiding Principles & Technical Design of GTU test identifiers

• Suggested Uses of the Concert GTU in structured (e.g., claims) and unstructured healthcare communication

Finally, the paper summarizes how GTUs may be accessed on a royalty-free basis, and how to contact Concert for additional uses including derivative works.

The post The Genetic Testing Unit (GTU) appeared first on Concert.

The genetic testing market is growing fast and evolving rapidly. With more than 150,000 clinically orderable genetic tests on the market, stakeholders are struggling to communicate effectively and efficiently across the Genetic Health Information Network. One significant challenge is coding genetic tests for reimbursement. This is seen in claims data, where variation in coding correlates with variation in pricing.

Concert has developed a novel method to translate a genetic test into a single code or code combination. This paper describes this method, the Concert Coding Engine, including the objectives, guiding principles, data inputs, underlying logic, and the limitations of the current implementation.

The paper concludes with a brief discussion on how stakeholders may access and deploy the Concert Coding Engine.

To access the counterpart to this paper, see: Coding Variability in Genetic Testing: A summary of coding and pricing variation in commercial health insurance claims

The post A Coding Solution for Genetic Testing (v1.1) appeared first on Concert.

Update (June 2020):
A more recent version of this paper is available here.

The genetic testing market is growing fast and evolving rapidly. With more than 140,000 clinically orderable genetic tests on the market, stakeholders are struggling to communicate effectively and efficiently across the Genetic Health Information Network. One significant challenge is coding genetic tests for reimbursement. This is seen in claims data, where variation in coding correlates with variation in pricing.

Concert has developed a novel method to translate a genetic test into a single code or code combination. This paper describes this method, the Concert Coding Engine, including the objectives, guiding principles, data inputs, underlying logic, and the limitations of the current implementation.

The paper concludes with a brief discussion on how stakeholders may access and deploy the Concert Coding Engine.

To access the counterpart to this paper, see: Coding Variability in Genetic Testing: A summary of coding and pricing variation in commercial health insurance claims

The post A Coding Solution for Genetic Testing (v1.0) appeared first on Concert.

The quantity, variety, and complexity of clinical genetic tests on the market have grown rapidly over the last decade. The elimination of patent protection on human genes, the proliferation of next-generation sequencing (NGS) technology, and the rapid discovery of gene-disease connections have all contributed to this trend.

This paper explores one result of this growth: Variation in the application of billing codes for commercial insurance reimbursement.

Concert analyzed 2.2 million commercial genetic testing claims from 2016-2018, representing a population of more than 35 million lives, to quantify how uniformly (or variably) billing codes are being applied in commercial insurance reimbursement.

Figures include:

1. Average number of codes per claim by domain of genetic testing
2. Number of distinct code signatures observed within each domain
3. Standard deviation of reimbursements observed within each domain
4. Correlation between code variation and price variation

Concludes with a discussion of the impact of coding and price variation on key stakeholders in the Genetic Health Information Network.

To access the counterpart to this paper, see: Coding Solution for Genetic Testing: A coding engine for accurate and consistent coding of genetic tests

The post Coding Variability in Genetic Testing appeared first on Concert.