Diagnostic Benefit Program
The definitive precision health payment accuracy and clinical content solution for health plans is here. The Concert Diagnostic Benefit Program automates accurate payment and consistent coverage decisions by aligning medical policy, payment policy, claim editing, and payment integrity on a cohesive platform that integrates into your workflow.
The pace of change in diagnostics and therapeutics is accelerating, driven by scientific discovery and market growth. Health plans face complex coding, rapidly changing guidelines, payment errors, and appeals that lead to significant cost and confusion.
Deliver on The Promise of Precision Health
Concert’s definitive solution for diagnostic payment accuracy aligns care and payment for laboratory testing.
The Diagnostic Benefit Program provides customers unparalleled clarity into this rapidly evolving space by leveraging the market’s only integrated platform of tests, coding, evidence, policy, and payment rules.
Components
Payment Policy
Bring consistency and transparency to coding with a payment policy that simplifies clinical review and aligns with pre-pay claim edits. One simple policy ensures coding consistency across hundreds of thousands of tests.
Medical Policy
The market’s most sophisticated, machine-readable policies are also the easiest to use. Access clear, easy-to-navigate medical policies built for automated payment accuracy and simple, streamlined clinical review.
Payment Accuracy
Apply the most accurate and comprehensive pre-pay claim edits to enforce the integrated policy content within your preferred claim editor.
Concert in Action
The Concert solution is flexible and easy to implement.
01
Payment Policy
Concert provides implementation support and lab onboarding services. Implementation is straightforward because only one (1) policy is required, and labs representing the vast majority of test volume have already agreed to follow Concert’s coding standards for plans that issue the policy.
02
Medical Policy
Concert provides policy documents for the plan to adopt and/or delivers criteria through the clinical decision support platform preferred by the plan.
03
Claim Editing
No need for a new feed. Concert’s real-time, pre-pay edits are available through partnerships with leading claim editors and automatically kept in sync with payment and medical policy.
04
Monitoring & Reporting
Concert provides monitoring and reporting to verify provider adherence and successful program operations. Using its patented machine learning analytic model, Concert identifies tests represented by complex claims, providing unparalleled insight into payment integrity and program effectiveness.
What Concert Can Do For Your Organization
12-15%
Medical Cost Savings
30-50%
Reduction in Codes Per Claim
50-70%
Reduced Need for Prior Auth
Examples represent typical ranges, not guarantees. Customer results may vary.
Connect With Concert
Wonder how Concert’s Diagnostic Benefit Program could transform precision health for your organization? Fill out the form, and our team will be in touch soon.