Genetic and Molecular Testing Services Payment Policy
Governs billing and payment requirements for genetic and molecular laboratory testing for Ambetter Nevada members, including coding, documentation, and use of Concert Genetics GTUs; applies to providers submitting claims and prior authorizations for these services.
Annual Review with minor rewording and updates including vendor name change to 'Concert' and updated code section listings and URL.
Reimbursement section reworded to require all providers billing genetic and molecular testing to include specific claim elements and to bill consistent with delivered test results.
Requirement that laboratories/providers register on the Concert Genetics portal and include the Concert GTU identifier on claims and prior authorization requests.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.