JACKSONVILLE, Fla. & NASHVILLE, Tenn.--(BUSINESS WIRE)--Availity^®, the nation’s leading real-time health information network, and Concert^®, the leading provider of clinical content and payment accuracy solutions for advanced diagnostics, have partnered to digitize and automate the prior authorization and payment processes for genetic tests. Together the companies will enable more consistent, transparent, and instantaneous prior authorizations, reducing administrative burden in the delivery of precision medicine.

With advancements in genetic diagnostics and therapies, providers are better able to personalize patient care. However, genetic testing is an evolving and complex space that is expensive to administer. These tests represent a disproportionately high number of prior authorization clinical reviews, and Utilization Management (UM) teams struggle to keep current with new tests, rapidly evolving clinical guidelines, and complex state-level biomarker regulations. These challenges extend to the health plan’s coding and billing functions. Frequently ordered prenatal, oncology, and pharmacogenetic tests are commonly billed with between two and 10 codes.¹ The complexity of these claims means they are more likely to be denied or held for manual review, leading to delay, waste, confusion, and frustration for plans, providers, and patients.

In an effort to solve these challenges, the companies will integrate Concert’s clinical criteria, coding standards, and Concert GTU^® test identifier with Availity’s End-to-End Authorization solution. Doing so will transform manual and error-prone administrative processes into automated authorization recommendations within existing health plan and provider workflows. The goal of this collaboration is that:

• Providers experience greater consistency and transparency in authorizations, many of which are rendered instantly,
• Health plans benefit from a streamlined prior authorization process, definitive knowledge of the service rendered, and reduced medical director burden surrounding complex authorization and claim reviews, and
• Patients benefit from less delay and uncertainty when their provider is ordering a genetic test, and fewer surprise bills after the fact.

“At Concert, we envision a day when laboratory test reimbursement is determined instantly at the point of patient care. To make this possible, Concert built a flexible data platform for policy and coding that integrates wherever work happens,” said Rob Metcalf, CEO of Concert. “Availity’s information network facilitates healthcare operations across the nation. Concert is delighted to power that network and together enable efficient, evidence-based precision health.”

“At Availity, our goal is to accelerate access to the right care by completely automating critical processes like prior authorization and payment accuracy. Our partnership with Concert represents a critical step forward in this mission by addressing clinically complex conditions, which are among the most time-consuming authorization requests,” said Matt Cunningham, Availity Executive Vice President of Product. “Availity seamlessly integrates Concert’s clinical content within UM workflows and across the care continuum, so health plans and providers have the insights needed to determine and deliver appropriate care, while reducing the wait times that prevent patients from receiving timely access to that care.”

About Availity
Availity empowers payers and providers to deliver transformative, patient-centered healthcare experiences by enabling the seamless exchange of clinical, administrative, and financial information within established workflows. As the nation's largest real-time health information network, Availity provides mission-critical connectivity and develops intelligent, automated, and interoperable solutions that foster collaboration and deliver shared value across the healthcare ecosystem through omni-channel connectivity. Availity's robust, cloud-first technology platform maximizes efficiency, security, and resiliency through responsible use of AI, data-driven insights, extensive partnerships, and a diversified product portfolio. With connections to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, Availity is setting the standards for the future of disciplined healthcare innovation.

For more information about Availity, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn and X.

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. Concert Genetics now operates by its abbreviated name, Concert. For more information, visit www.concert.co.