The effort required to manage genetic testing can seem endless, despite the fact it is a small area of spend. Market trends suggest this will continue. Volumes are growing, and so is the complexity of medical policy, coding, and utilization review. Several factors make this area unique:

• More tests: 150,000+ genetic tests are on the market, compared to 10,000 in 2012, with limited ability to compare quality and value.

• Complex claims: On average, 6.9 codes are billed to represent a single genetic test.

• Cumbersome policies: Up to 1,000 pages of medical policy offer no clear answer for many tests.

Health plans that rely on outdated management approaches are experiencing a growing volume of prior authorizations, denials, reviews, and appeals – all made more complex by multi-gene panel tests with multiple billing codes. The result is waste, variable quality, and frustrated members, providers, and medical directors.

The Concert Genetics Benefit Program is a transformative solution – more effective, more automated, and less burdensome than traditional approaches. It is built on three key components:

• Quality Laboratories: High-quality, high-value labs that commit to quality standards, billing integrity, and reducing denials from inappropriate claims

• Policies + Rules: Machine-readable medical policies to apply evidence-based standards through rules, and reimbursement policy to establish clear expectations with laboratories

• Technology Platform: A one-of-a-kind, comprehensive platform that links all genetic tests with policies, codes, and prices, enabling claim edits and other automation

Because Concert offers a sophisticated platform that automates (or eliminates) manual work, the program can deliver better results at a lower cost and with less abrasion than traditional utilization management.

Concert delivers quality and value while simplifying every aspect of genetic testing management. Benefits include:

• Quality: Access to labs with high quality standards

• Flexibility: Reduced administrative and medical costs regardless of utilization management approach or vendor

• Provider Ease: Efficiency without taking away benefits from members or placing new burdens on providers

Health plans that engage Concert Genetics can enjoy the confidence of working with leading experts and accessing valuable insights in this critical area of medicine.

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