Concert
Concert is a Nashville-based healthcare technology company that provides payment accuracy, coding, and test order management software for genetic and precision diagnostics, serving health plans, hospitals, and laboratories through its GTU Test Identifier, Coding Engine, and machine-readable clinical policy platform.
- Company typePrivate
- Founded2010
- HeadquartersNashville, United States
- Headcount11–50
- GTM typeB2B
- OfferingSoftware
What Concert does
Concert is a Nashville-based healthcare technology company that builds payment accuracy and test order management infrastructure for the U.S. precision diagnostics market. Founded in 2010 as NextGxDx (rebranded to Concert Genetics in 2017 and to Concert in May 2024), the company maintains a proprietary catalog of 160,000+ genetic testing products, the GTU® (Genetic Testing Unit) Test Identifier standard, and the Concert Coding Engine that translates each genetic test into a single code or code combination to eliminate ambiguity in claims coding. Its platform combines clinical criteria, coding rules, medical policy content, and machine-readable guidelines delivered via cloud-based API for integration into EHR, prior authorization, and pre-payment claim editing workflows.
The company serves three primary customer segments: health plans (payment accuracy, claim editing, prior authorization, utilization management), hospitals and health systems (test ordering guidance, insurance alignment, clinical decision support), and clinical laboratories (coding standardization, reimbursement support, and market access). Revenue is generated primarily through enterprise software subscriptions sold to health plans and large healthcare organizations, supplemented by a free tier for the public test registry. The free tier functions as a top-of-funnel acquisition channel, while paid enterprise contracts are quote-based, typically structured as annual subscriptions.
Distribution is heavily partner-mediated. Concert's clinical content, GTU identifiers, and coding standards are embedded inside Availity's End-to-End Authorization solution (covering 95%+ of U.S. payers and 3M+ providers), EviCore by Evernorth's authorization guidelines, and Lyric's payment accuracy platform (Lyric delivers over $14 billion in annual payment accuracy savings). These channel partnerships, combined with direct enterprise sales, form the company's go-to-market architecture and are the primary mechanism by which Concert reaches enterprise healthcare buyers at scale.
Concert firmographics
Firmographics- Name
- Concert
- Legal name
- Concert Genetics, Inc.
- Website
- https://concert.co
- Company type
- Private
- Founded year
- 2010
- Operating status
- Operating
- Headcount range
- 11–50 employees
- Short description
- Concert is a Nashville-based healthcare technology company that provides payment accuracy, coding, and test order management software for genetic and precision diagnostics, serving health plans, hospitals, and laboratories through its GTU Test Identifier, Coding Engine, and machine-readable clinical policy platform.
- Ownership category
- akta.pro rank
Where Concert is headquartered
LocationHeadquarters
- HQ city
- Nashville
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Concert business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Personnel, Technology or R&D, Marketing or Sales, Operations, Infrastructure
Revenue model
- Enterprise Software Subscriptions: Concert provides software, policy, and coding solutions to health plans, providers, and laboratories through enterprise licensing arrangements. The platform is sold as an integrated solution with cloud-based deployment and API access.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Freemium | Annual | Free tier for basic access to test registry and policies |
Go-to-market motion1 record
Distribution channels2 records
Marketing channels5 records
Concert product offering
Product offeringCore offering
Concert delivers a cloud-based, integrated precision health payment accuracy platform that combines a catalog of 160,000+ genetic testing products, the proprietary GTU Test Identifier, the Concert Coding Engine, and machine-readable medical policies. The platform is sold as enterprise software to health plans, providers, and laboratories, enabling automated claim editing, prior authorization, test order management, and diagnostic benefit program administration via cloud API integrations into clinical and financial workflows.
Product overview
Concert offers a unified precision health payment accuracy platform consisting of multiple integrated modules. The core platform harmonizes evidence, policy, coding, and payment through products including the GTU Test Identifier (standardized test identification), Payment Accuracy (automated claim editing), Medical Policy (clinical criteria), Test Order Management, Network Management, and Test Result Integration. The Concert Coding Engine translates genetic tests into standardized code combinations. These solutions are delivered via cloud-based API integration into clinical and financial workflows, serving health plans, providers, and laboratories.
Differentiator
Problem solved
Functional benefit
Products and services
- Precision Health Payment Accuracy Platform Cloud-based, integrated platform combining tests, coding, evidence, policy, and payment rules to provide clarity in precision health. Delivers evidence-based policy and real-time intelligence directly into clinical and financial workflows for health plans, providers, and laboratories.
- GTU Test Identifier A proprietary test identifier that standardizes genetic test identification across the healthcare ecosystem, enabling consistent communication for ordering, resulting, coding, coverage, and payment of genetic tests.
- Payment Accuracy Solution for harmonizing guidelines, policy, coding, and payment for automation that health plans and providers trust. Delivers automated claim editing and payment accuracy for genetic and laboratory testing.
- Medical Policy Machine-readable, evidence-based clinical criteria for advanced diagnostics including genetic testing and infectious disease testing, providing clinical decision support content deployable via API into EHR, prior authorization, and claim editing workflows.
- Test Order Management System for guiding the genetic test order management process, enabling efficiency, stewardship, and insurance alignment for providers and hospitals ordering precision diagnostic tests.
- Network Management Solution for managing provider network considerations related to diagnostic and precision health services.
- Test Result Integration Solution enabling integration of test results into clinical workflows and systems used by providers and laboratories.
- Diagnostic Benefit Program Solution for health plans to manage laboratory testing, covering genetic testing, outpatient infectious disease testing, and broader diagnostic services through integrated policy and payment accuracy.
- Concert Coding Engine Solution that translates each genetic test into a single code or code combination to eliminate ambiguity and inconsistency in genetic test claims coding across the industry.
- Test Registry Free searchable catalog of genetic tests, coding standards, and reference medical policies available through Concert's online platform, providing transparency into the genetic testing market.
Quantifiable outcome
- Reduces administrative burden through automation of prior authorization and claim editing processes
- +2 more outcomes
Companies that use Concert
Customer profileNamed customers3 records
Segments3 records
Ideal customer profiles3 records
Concert technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration3 records
AI capability4 records
Feature4 records
Concert partnerships and signals
Strategic signalPartnerships
Four partnerships are on record, tiered core.
- AvailitycorePartnership to digitize and automate prior authorization and payment processes for genetic tests. Integrates Concert's clinical criteria, coding standards, and GTU test identifier with Availity's End-to-End Authorization solution. Goal is to enable more consistent, transparent, and instantaneous prior authorizations, reducing administrative burden in precision medicine delivery. Availity is the nation's leading real-time health information network with connections to over 95% of payers and more than 3 million providers.
- EviCorecoreStreamline prior authorization for genetic testing by integrating Concert's coding standards and GTU test ID with EviCore's clinical guidelines. Alignment of clinical and administrative guidelines enables fewer, simpler authorizations and improves efficiency and transparency. EviCore is part of Evernorth and provides medical policies and authorization guidelines.
- LyriccoreExpanded partnership to deliver the Diagnostics Module (formerly Genetic Testing Module) for laboratory payment accuracy across a growing scope of advanced and routine laboratory tests. Addresses outpatient infectious disease testing, the largest area of outpatient lab spend for many health plans. Lyric is an AI-first leader in payment accuracy delivering over $14 billion of annual savings with recognition from KLAS as a 'true partner' with top customer satisfaction scores.
- Lyric (formerly ClaimsXten Portfolio)coreInitial partnership to make Concert's genetic test payment accuracy capabilities available through Lyric's ClaimsXten product, enabling claim editing for genetic tests.
Scale indicators4 records
Recent moves8 records
Expansion highlights5 records
Concert competitors and assessment
Company assessmentDirect peers
- Availity: Availity is the nation's largest real-time health information network connecting 95%+ of payers with 3M+ providers for prior authorization and clinical workflows. Comparable to Concert as a healthcare data and authorization infrastructure provider, and also a strategic partner.
- Lyric (formerly ClaimsXten): Lyric is an AI-first payment accuracy company delivering $14B+ in annual savings, and is itself a major Concert partner (ClaimsXten/Diagnostics Module). Comparable to Concert in payment accuracy and claim editing, with AI-driven capabilities and broader lab/payment categories.
- MCG (Hearst Health): MCG provides evidence-based clinical decision support and care guidelines used by health plans and providers for utilization management and prior authorization. Highly comparable to Concert's clinical policy content product, with similar integration into payer workflows.
- EviCore (Evernorth/Cigna): EviCore is a leading medical benefits management provider for prior authorization and clinical guidelines, and is itself a Concert partner. Highly comparable as a peer in clinical policy-driven prior authorization, particularly for advanced diagnostics and specialty services.
- Cotiviti: Cotiviti specializes in payment accuracy, claim editing, and analytics for healthcare payers, with deep capabilities in clinical and coding content for medical and pharmacy claims. A direct peer to Concert in payment integrity, though Cotiviti operates at much larger scale across broader claim categories.
Emerging players
- Edifecs: Edifecs provides healthcare data interoperability, payment integrity, and clinical content solutions for payers and providers. Comparable to Concert in healthcare data integration and policy-driven claim editing, with broader enterprise footprint.
- Infinx: Infinx provides AI-driven prior authorization and revenue cycle management for healthcare providers and payers, with overlap to Concert's prior authorization automation focus. A smaller but fast-growing peer in the diagnostic test authorization category.
- Zynx Health: Zynx Health provides evidence-based clinical decision support and care guidance content for healthcare organizations. Comparable to Concert's medical policy content, focused on clinical content delivery to EHR and workflow systems.
Broad incumbents
- Change Healthcare (Optum): Change Healthcare, now part of Optum, is a leading healthcare technology vendor providing claim editing, payment accuracy, and revenue cycle solutions. Highly comparable to Concert in payment accuracy and clinical content delivery, but at vastly greater scale and across all clinical domains.
- Optum (UnitedHealth Group): Optum is the largest healthcare services and innovation arm of UnitedHealth Group, offering payment accuracy, claim editing, and analytics at massive scale through Change Healthcare. Comparable to Concert as a broad incumbent in payment accuracy with overlapping capabilities, though Optum's portfolio extends far beyond diagnostics.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights6 records
Customer concentration
Concert social profiles
Digital presenceConcert financial estimates
Financial estimateRevenue estimate
Valuation estimate
Concert leadership team
Management profileNumber of profiles
Profiles3 records
Concert funding detail
Funding detailFunding overview
Funding rounds2 records
Investors1 record
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Concert M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Concert
What does Concert do?
Concert delivers a cloud-based, integrated precision health payment accuracy platform that combines a catalog of 160,000+ genetic testing products, the proprietary GTU Test Identifier, the Concert Coding Engine, and machine-readable medical policies. The platform is sold as enterprise software to health plans, providers, and laboratories, enabling automated claim editing, prior authorization, test order management, and diagnostic benefit program administration via cloud API integrations into clinical and financial workflows.
Is Concert a public or private company?
Concert is a private company. It is classified as venture growth investor backed and is currently operating.
When was Concert founded?
Concert was founded in 2010. It employs 11 to 50 people.
Where is Concert based?
Concert is headquartered in Nashville, United States, in the North America region.
How does Concert make money?
One revenue line is on record: enterprise Software Subscriptions.
Who are Concert's main competitors?
Direct peers on record are Availity, Lyric (formerly ClaimsXten), MCG (Hearst Health), EviCore (Evernorth/Cigna) and Cotiviti. Emerging players are Edifecs, Infinx and Zynx Health. Broad incumbents are Change Healthcare (Optum) and Optum (UnitedHealth Group).
Does Concert have an API?
Yes. Concert provides an API that delivers machine-readable clinical criteria for automation in EHR, prior authorization, and pre-payment claim editing workflows. The API enables integration of clinical policy content into partner platforms and workflows.