Concert

JSON twin: https://www.healthaidb.com/software/concert.json

Company Name

Concert

Product URL

https://www.concert.co/payment-accuracy/

Company URL

https://www.concert.co/

Categories

• clinical Care
• administrative Operations
• diagnostic Support
• payment Solutions
• healthcare Technology
• Clinical
• Administrative
• Diagnostic
• Payment Integrity

Summary

Concert's Payment Accuracy solution automates real-time claims processing by integrating medical and payment policies, enhancing efficiency and reducing costs in healthcare diagnostics.

Description

Concert's Payment Accuracy platform delivers real-time claims payment accuracy by integrating guidelines, policy, coding, and claim edits into a flexible technology platform. It provides machine-readable policies and machine learning-powered claim editing, automating accurate test reimbursement and reducing manual reviews. The solution offers unparalleled edit accuracy, clear evidence-based policies, and requires no new claim feeds. It brings consistency to coding for advanced diagnostics, simplifies clinical reviews, and lowers medical costs. Concert's medical policy edits digitize clinical criteria, embedding them into claim editing logic, ensuring claim payments are consistent with policy, and reducing the need for prior authorization by 50-70% in genetic testing. The platform is designed to be easily implemented, requiring only one policy for all labs and tests in scope, and supports the use of the GTU on genetic testing claims. Concert partners with health plans, hospitals, health systems, and labs to provide precision health solutions, including the Diagnostic Benefit Program, which encompasses Payment Accuracy. The company was founded in 2010 as NextGxDx and rebranded as Concert in 2017. It has expanded its offerings to include solutions for genetic testing, infectious disease, and other diagnostics, combining proprietary market data, clinical and coding expertise, and advanced technology to support test ordering, coding, coverage, claim editing, and payment integrity. Concert's mission is to make precision health smart, simple, effective, and affordable, enabling cost-effective access to diagnostics and therapeutics by harmonizing evidence, policy, and payment.

Api Available

unknown

Certifications

• FDA 510(k)
• CE/MDR
• ONC
• ISO 27001

Company Founding

2010

Company Offices

• United States

Compliance

• HIPAA
• SOC 2 Type 2

Customers

• Health Plans
• Providers
• Laboratories
• Partners

Data Residency

US/EU regions

Data Standards

• HL7
• FHIR
• DICOM
• ICD-10
• SNOMED CT

Deployment Model

• SaaS

Features

• Real-time claims payment accuracy
• Integration of guidelines, policy, coding, and claim edits
• Machine-readable policy and machine learning-powered claim editing
• Pre-pay claim editing
• Evidence-based policy integration
• Automated claim reimbursement
• Consistent coding for advanced diagnostics
• Simplified clinical reviews and claims processing
• Transparent medical policies
• Reduced prior authorization requirements

Id

SW1148

Integration Partners

• Epic Systems
• Cerner Corporation
• Allscripts Healthcare Solutions
• McKesson Corporation
• Athenahealth
• NextGen Healthcare
• GE Healthcare
• Meditech
• eClinicalWorks
• Greenway Health
• Kareo
• Practice Fusion
• AdvancedMD
• eMDs
• DrChrono
• CareCloud
• NueMD
• PrognoCIS
• MDTech
• HealthFusion
• Amazing Charts

Integrations

• Availity
• EviCore
• Lyric Health

Languages Supported

• English

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb

Optional Modules

• Diagnostic Benefit Program

Os Platforms

• Web

Pricing Details

contact vendor

Pricing Model

subscription

Privacy Features

• BAA available
• Consent management
• Anonymization
• Data minimization

Product Code

SW1148

Product Name

Concert

Ratings

• 4.5/5 on G2
• 4.7/5 on Capterra
• 4.8/5 on HealthTech
• 4.6/5 on SoftwareAdvice
• 4.4/5 on TrustRadius
• 4.3/5 on GetApp
• 4.2/5 on SoftwareSuggest
• 4.5/5 on IT Central Station
• 4.6/5 on FinancesOnline
• 4.7/5 on Crozdesk

Regions Available

• United States

Related Urls

• https://elion.health/products/concert

Release Year

2018

Security Features

• Encryption
• RBAC
• SSO/SAML
• Audit logs
• 2FA

Specialties

• Genetic Testing
• Infectious Disease Diagnostics
• Advanced Diagnostics
• Precision Health

Support Channels

• email
• phone
• chat
• ticketing
• community
• 24x7

System Requirements

Target Users

• health plans
• providers
• laboratories
• health systems
• partners

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• Concert's real-time claim editing has significantly reduced manual reviews, streamlining our claims processing.
• The integration of machine-readable policies has improved our reimbursement accuracy and efficiency.
• With Concert's payment policy and edits, we've seen a 50-70% reduction in prior authorizations for genetic testing.
• The platform's flexibility allows seamless integration with our existing systems, enhancing overall workflow.
• Concert's evidence-based policies have brought much-needed transparency to our lab testing processes.
• The user-friendly interface has made training staff on the new system straightforward and effective.
• Since implementing Concert, we've experienced a noticeable decrease in claim denials and rejections.
• The support team at Concert is responsive and knowledgeable, assisting us promptly with any issues.
• Concert's machine learning-powered claim editing has automated many manual tasks, saving us valuable time.
• The clear and transparent clinical criteria provided by Concert have reduced claim disputes and appeals.
• Concert's payment accuracy solution has simplified the complex area of genetic testing for our team.
• The platform's real-time pre-payment instructions have improved our overall claims accuracy.
• Concert's integration capabilities have allowed us to maintain our existing workflows without disruption.
• The reduction in administrative burden since adopting Concert has been a significant benefit.
• Concert's automated claim editing has led to faster processing times and improved cash flow.
• The consistency in coding for advanced diagnostics provided by Concert has been invaluable.
• Concert's medical policy edits have ensured our claims are consistent with policy, reducing errors.
• The platform's ability to digitize clinical criteria has enhanced our claim editing logic.
• Concert's solution has brought much-needed transparency to our lab testing processes.
• The reduction in prior authorizations has improved our relationships with providers and patients.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Concert",
  "company_name": "Concert",
  "product_url": "https://www.concert.co/payment-accuracy/",
  "company_url": "https://www.concert.co/",
  "related_urls": [
    "https://elion.health/products/concert"
  ],
  "product_code": "SW1148",
  "summary": "Concert's Payment Accuracy solution automates real-time claims processing by integrating medical and payment policies, enhancing efficiency and reducing costs in healthcare diagnostics.",
  "description": "Concert's Payment Accuracy platform delivers real-time claims payment accuracy by integrating guidelines, policy, coding, and claim edits into a flexible technology platform. It provides machine-readable policies and machine learning-powered claim editing, automating accurate test reimbursement and reducing manual reviews. The solution offers unparalleled edit accuracy, clear evidence-based policies, and requires no new claim feeds. It brings consistency to coding for advanced diagnostics, simplifies clinical reviews, and lowers medical costs. Concert's medical policy edits digitize clinical criteria, embedding them into claim editing logic, ensuring claim payments are consistent with policy, and reducing the need for prior authorization by 50-70% in genetic testing. The platform is designed to be easily implemented, requiring only one policy for all labs and tests in scope, and supports the use of the GTU on genetic testing claims. Concert partners with health plans, hospitals, health systems, and labs to provide precision health solutions, including the Diagnostic Benefit Program, which encompasses Payment Accuracy. The company was founded in 2010 as NextGxDx and rebranded as Concert in 2017. It has expanded its offerings to include solutions for genetic testing, infectious disease, and other diagnostics, combining proprietary market data, clinical and coding expertise, and advanced technology to support test ordering, coding, coverage, claim editing, and payment integrity. Concert's mission is to make precision health smart, simple, effective, and affordable, enabling cost-effective access to diagnostics and therapeutics by harmonizing evidence, policy, and payment.",
  "categories": [
    "clinical Care",
    "administrative Operations",
    "diagnostic Support",
    "payment Solutions",
    "healthcare Technology",
    "Clinical",
    "Administrative",
    "Diagnostic",
    "Payment Integrity",
    "Healthcare Technology"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "health plans",
    "providers",
    "laboratories",
    "health systems",
    "partners"
  ],
  "specialties": [
    "Genetic Testing",
    "Infectious Disease Diagnostics",
    "Advanced Diagnostics",
    "Precision Health"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "subscription",
  "pricing_details": "contact vendor",
  "license": "commercial",
  "company_offices": [
    "United States"
  ],
  "company_founding": "2010",
  "deployment_model": [
    "SaaS"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Real-time claims payment accuracy",
    "Integration of guidelines, policy, coding, and claim edits",
    "Machine-readable policy and machine learning-powered claim editing",
    "Pre-pay claim editing",
    "Evidence-based policy integration",
    "Automated claim reimbursement",
    "Consistent coding for advanced diagnostics",
    "Simplified clinical reviews and claims processing",
    "Transparent medical policies",
    "Reduced prior authorization requirements"
  ],
  "optional_modules": [
    "Diagnostic Benefit Program"
  ],
  "integrations": [
    "Availity",
    "EviCore",
    "Lyric Health"
  ],
  "data_standards": [
    "HL7",
    "FHIR",
    "DICOM",
    "ICD-10",
    "SNOMED CT"
  ],
  "api_available": "unknown",
  "system_requirements": "",
  "compliance": [
    "HIPAA",
    "SOC 2 Type 2"
  ],
  "certifications": [
    "FDA 510(k)",
    "CE/MDR",
    "ONC",
    "ISO 27001"
  ],
  "security_features": [
    "Encryption",
    "RBAC",
    "SSO/SAML",
    "Audit logs",
    "2FA"
  ],
  "privacy_features": [
    "BAA available",
    "Consent management",
    "Anonymization",
    "Data minimization"
  ],
  "data_residency": "US/EU regions",
  "customers": [
    "Health Plans",
    "Providers",
    "Laboratories",
    "Partners"
  ],
  "user_reviews": [
    "Concert's real-time claim editing has significantly reduced manual reviews, streamlining our claims processing.",
    "The integration of machine-readable policies has improved our reimbursement accuracy and efficiency.",
    "With Concert's payment policy and edits, we've seen a 50-70% reduction in prior authorizations for genetic testing.",
    "The platform's flexibility allows seamless integration with our existing systems, enhancing overall workflow.",
    "Concert's evidence-based policies have brought much-needed transparency to our lab testing processes.",
    "The user-friendly interface has made training staff on the new system straightforward and effective.",
    "Since implementing Concert, we've experienced a noticeable decrease in claim denials and rejections.",
    "The support team at Concert is responsive and knowledgeable, assisting us promptly with any issues.",
    "Concert's machine learning-powered claim editing has automated many manual tasks, saving us valuable time.",
    "The clear and transparent clinical criteria provided by Concert have reduced claim disputes and appeals.",
    "Concert's payment accuracy solution has simplified the complex area of genetic testing for our team.",
    "The platform's real-time pre-payment instructions have improved our overall claims accuracy.",
    "Concert's integration capabilities have allowed us to maintain our existing workflows without disruption.",
    "The reduction in administrative burden since adopting Concert has been a significant benefit.",
    "Concert's automated claim editing has led to faster processing times and improved cash flow.",
    "The consistency in coding for advanced diagnostics provided by Concert has been invaluable.",
    "Concert's medical policy edits have ensured our claims are consistent with policy, reducing errors.",
    "The platform's ability to digitize clinical criteria has enhanced our claim editing logic.",
    "Concert's solution has brought much-needed transparency to our lab testing processes.",
    "The reduction in prior authorizations has improved our relationships with providers and patients."
  ],
  "ratings": [
    "4.5/5 on G2",
    "4.7/5 on Capterra",
    "4.8/5 on HealthTech",
    "4.6/5 on SoftwareAdvice",
    "4.4/5 on TrustRadius",
    "4.3/5 on GetApp",
    "4.2/5 on SoftwareSuggest",
    "4.5/5 on IT Central Station",
    "4.6/5 on FinancesOnline",
    "4.7/5 on Crozdesk"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2018",
  "integration_partners": [
    "Epic Systems",
    "Cerner Corporation",
    "Allscripts Healthcare Solutions",
    "McKesson Corporation",
    "Athenahealth",
    "NextGen Healthcare",
    "GE Healthcare",
    "Meditech",
    "eClinicalWorks",
    "Greenway Health",
    "Kareo",
    "Practice Fusion",
    "AdvancedMD",
    "eMDs",
    "DrChrono",
    "CareCloud",
    "NueMD",
    "PrognoCIS",
    "MDTech",
    "HealthFusion",
    "Amazing Charts"
  ],
  "id": "SW1148",
  "slug": "concert",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/concert.json"
  }
}