Data Sheet: Simplify Genetic Test Claim Complexities with Concert Genetics and Source

Concert Genetics and HealthEdge Source (Source) have teamed up to address the rising complexities in genetic test claims. With advancements in genetic testing and the increasing number of tests, the medical policy, coding, and utilization review processes have become more complex. The surge in genetic testing has captured the public's interest and gained acceptance from healthcare professionals for its potential in early intervention and precision medicine.

However, without proper management, payers can face an overwhelming number of prior authorizations, denials, reviews, and appeals, which can hinder payment integrity. To mitigate these challenges, Source has integrated Concert Genetics' solutions into its ecosystem.

Key Features and Benefits of Concert Genetics Integrated with Source

• Comprehensive Genetic Test Edits: Concert Genetics offers nearly 40 active edits, including clinical edits that flag tests typically not covered by health plans, and coding edits based on the latest procedure codes and guidelines from the AMA.
• Streamlined Workflow: Source's unique extensibility allows seamless integration of third-party solutions, managing all content updates and administrative overhead. This results in a cohesive workflow, enhancing accuracy and automation in genetic test edits.
• Wide Claim Coverage: Concert Genetics covers a wide range of claims, including molecular pathology, genomic sequencing procedures, proprietary laboratory analyses, and multianalyte assays with algorithmic analyses.

By leveraging Concert Genetics’ advanced technology, healthcare organizations can improve the accuracy and efficiency of genetic test claim processes, ultimately enhancing patient care and operational effectiveness.