Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
AmbetterExchange · Coverage · Claims & Billing · NE · Infectious Disease, Family Medicine, Internal Medicine +4 moreHigh impact

Concert Genetics Policies

Act
by Aug 15, 2026
Effective date
Sep 1, 2026
Identified
Aug 26, 2026

Summary

Ambetter Health is implementing seven new Concert Genetics policies effective September 1, 2026, establishing clinical and payment criteria for infectious disease lab testing across multiple categories (respiratory, multi-system, dermatologic, gastroenterologic, preventive screening, vector-borne, and genitourinary). A new laboratory payment policy (CG.CC.PP.01) outlines correct coding requirements for lab and molecular testing. Billing teams must obtain and review the full policy text to identify specific coding impacts and prior authorization requirements.

Get alerts when payers change rules like this one

We check Ambetter and other payers every day and email you when a change matches your specialty and state.

Get Ambetter alertsPolicy Monitoring is free. No card required.

What to do

by Aug 15, 2026 · 5 steps
01Billing team must request full policy text from Ambetter Health Provider Services (1-833-890-0329, TTY 711) for all seven Concert Genetics policies (CG.CP.MP.01 through CG.CP.MP.07 and CG.CC.PP.01).
02Review policies to identify: (1) specific CPT/HCPCS codes affected, (2) prior authorization requirements, (3) medical necessity criteria, and (4) coding rule changes.
03Update billing software, encounter forms, and provider documentation templates accordingly.
04Before September 1, 2026: Train billing staff and providers on new requirements.
05Communicate any prior auth workflows or coding changes to clinical staff.
If missed: Failure to comply may result in claim denials for infectious disease lab testing.

Original notice

Concert Genetics Policies
ambetterhealth.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Ambetter policiesNE policy changesInfectious DiseaseFamily MedicineInternal MedicinePediatricsGeneral PracticeEmergency MedicineOB-GYN

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account