{"id":1553,"date":"2025-01-09T15:17:43","date_gmt":"2025-01-09T15:17:43","guid":{"rendered":"https:\/\/www.concert.co\/?p=1553"},"modified":"2025-01-09T15:27:30","modified_gmt":"2025-01-09T15:27:30","slug":"availity-concert-partner-to-digitize-and-automate-prior-authorization-for-genetic-testing","status":"publish","type":"post","link":"https:\/\/www.concert.co\/blog\/availity-concert-partner-to-digitize-and-automate-prior-authorization-for-genetic-testing\/","title":{"rendered":"Availity, Concert Partner to Digitize and Automate Prior Authorization for Genetic Testing"},"content":{"rendered":"\n

Partnership will enable more authorizations to be issued instantly with less administrative burden on clinicians<\/em><\/h4>\n\n\n\n

JACKSONVILLE, Fla. and NASHVILLE, Tenn. <\/strong>\u2013 Availity\u00ae<\/sup><\/a>, the nation\u2019s leading real-time health information network, and Concert\u00ae<\/sup>, 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.\u00a0 \u00a0\u00a0\u00a0<\/p>\n\n\n\n

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\u2019s coding and billing functions. Frequently ordered prenatal, oncology, and pharmacogenetic tests are commonly billed with between two and 10 codes<\/a>. 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.<\/p>\n\n\n\n

In an effort to solve these challenges, the companies will integrate Concert\u2019s clinical criteria, coding standards, and Concert GTU\u00ae<\/a> test identifier with Availity\u2019s 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: <\/p>\n\n\n\n