Genetic Testing Policy Update

Date: 04/22/24

Background

Advancements in the science of genetics and genomics have led to remarkable new options for medical professionals to diagnose, treat, and prevent disease. As genetic testing has increasingly become the standard of care, our health plan is committed to providing the highest levels of access, quality, and value for members in this exciting and dynamic segment of health care.

To achieve these goals, our health plan is asking for your support in the next phase of its genetic testing program. The goals of this phase are twofold -- advance the reliability of laboratory quality information and reduce variability in billing.

Beginning June 1, 2024, Centene’s Michigan lines of business (including Meridian, MeridianComplete, Ambetter from Meridian, Wellcare) will expand the requirements for billing of genetic and molecular testing. In accordance with the Reimbursement Policy for Genetic and Molecular Test Coding Policy, all providers billing for genetic and molecular testing services will be required to adhere to the coding recommendation in the Concert Genetics portal.

Also beginning June 1, 2024, Centene’s Michigan lines of business (including Meridian, MeridianComplete, Ambetter from Meridian, Wellcare) will present new clinical payment policies to provide payment protocols for Infectious Disease Lab Screening and Testing. In accordance with the Laboratory Payment Policy, all providers billing for infectious disease testing services will be required to adhere to the coding recommendation in the Concert Genetics portal.

The portal can be accessed here: concertgenetics.com/join-centene. The quality and billing integrity requirements in the reimbursement policy will be facilitated by Concert Genetics--our partner and a software and managed services company that promotes health by providing the digital infrastructure for reliable and efficient management of genetic testing and precision medicine.

What does this mean for our laboratory partners?

We are asking you, our laboratory partner, to do the following:

• Register with Concert Genetics
• Self-report on quality metrics in a common framework supplied by Concert
  
• Verify accuracy of test catalog and view coding recommendations and fee schedule
  
• Utilize Concert’s recommended codes when billing for genetic and molecular tests

Thank you for your support and continued partnership on providing our members with access to high quality health care at an affordable price.