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New Century Health Parent Company Acquires Specialty Benefit Management Organization NIA

Keep Pace with the Complexities of Genetic Testing

Although genetic testing accounts for only about 1% to 2% of medical spend, health plans often dedicate a disproportionate amount of time—as much as 15% of clinical reviews and 20% of medical policies—to managing it. Errors and overpayments occur frequently, and waste is common. However, with NIA’s innovative genetic testing solution, powered by Concert Genetics, we conquer the complexities and deliver end-to-end value.

Expert-informed Policies and Guidelines

Board-certified clinical geneticists and specialty-matched physicians trained extensively in genetic and molecular testing services review pended cases to ensure medical necessity and clinical appropriateness.

  • Maximize program value through medical necessity reviews for high-cost tests with high potential for misuse
  • Identify relevant medical policies by mapping machine-readable policies to categories and domains of testing
  • Focus on authorization of testing services provided rather than individual CPT codes

Robust Clinical Intake Algorithms

Our advanced system enables auto-approval for requests that meet medical necessity criteria.

  • Speed processes and lower costs
  • Reduce administrative burden and provider abrasion

Proprietary Technology Platform

Using artificial intelligence, all tests are automatically and continuously monitored and reviewed against medical guidelines, price benchmarks and correct codes.

  • Link all genetic and molecular tests with policies, codes and prices
  • Apply payment integrity and clinical claim edits to low-cost, high-volume tests

We can help you address the variation and complexity that exists in the genetic testing space while reducing costs through efficiency, transparency and automation. Contact us to learn more.