News | May 1, 2024

Concert Expands Diagnostic Benefit Program To Manage Laboratory Testing For Health Plans

Expanded solution, clinical advisory board, and new website set a path to bring transparency and efficiency to a growing set of health services

Nashville, TN /PRNewswire/ - Concert has expanded its Diagnostic Benefit Program, formerly known as the Genetics Benefit Program, to provide payment and clinical policies and payment accuracy capabilities across routine and advanced laboratory testing, enabling health plans to provide their members with access to these important clinical services at lower total costs, the company announced today.

"Diagnostics are critical in the delivery of effective, personalized care. Unfortunately, ambiguity in coverage, coding, and reimbursement leads to waste and confusion as providers, laboratories, and health plans work together to serve patients," said Rob Metcalf, CEO of Concert.

Laboratory testing has become complex and costly to manage, as new tests, evidence, clinical guidelines, and codes emerge rapidly. This quarter, almost 60 applications for Proprietary Laboratory Analyses (PLA) codes are under consideration.1 Meanwhile, frequently ordered molecular oncology, pharmacogenetic and infectious disease tests are commonly billed with more than 10 codes,2 often obscuring the test that was performed. As a result of the rapid changes underway, many health plans' policy and coding configurations lag behind the market, and payment errors are common.

The Diagnostic Benefit Program provides transparent, evidence-based policies, a synchronized library of claim edits, and technical integration capabilities that can deliver this content through the customer's preferred clinical decision support and claims editing platforms. Together these enable plans to improve transparency, reduce administrative burden and achieve cost savings, all while keeping pace with the rapidly evolving market.

In a separate release, Concert announced the formation of a clinical advisory board, which will advise Concert on its expanding set of clinical policy content. Advisors include Drs. Beth Harris, Thomas Holland, Girish Putcha, and Michele Schoonmaker.

"Expanding our clinical content, and the expertise that supports its development, means Concert can bring transparency, efficiency, and accurate reimbursement to more areas of care," said Gillian Hooker, Concert's Chief Scientific Officer. "Our goal is to deliver clarity of coverage and costs all the way to the point of care, and today's announcements represent important progress towards that goal."

More information about the Diagnostic Benefit Program and the clinical advisory board can be found at Concert's new website at With today's announcement, Concert Genetics will now operate by its abbreviated name, Concert, which many customers and partners have used for years to refer to the company.

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. For more information, visit

1 For more information on CPT® PLA codes visit: CPT® is a registered trademark of the American Medical Association.

2 Concert data

Source: Concert

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