December 2022

Laboratory Benefit Management Program: Reminders and Resources

Last month, we launched our Laboratory Benefit Management program with Avalon Healthcare Solutions for certain outpatient laboratory services provided to many of our commercial, non-HMO members. Some of the program goals are to reduce over-testing, lower cost variability and promote high quality care for our members. The Laboratory Benefit Management program supports a value-driven approach to outpatient laboratory testing as part of our commitment to provide affordable health insurance premiums for our members.

The Laboratory Benefit Management program applies to commercial outpatient laboratory claims (typically performed in an office, hospital outpatient, or independent laboratory setting) with dates of service beginning Nov. 1, 2022. Laboratory services provided in an emergency room, hospital observation or hospital inpatient setting are excluded from this program. Member coverage terms still apply.

We published articles in the Blue Review and News and Updates to alert you of changes, trainings and helpful resources, such as the Trial Claim Advice tool, available to registered users on Availity^® Essentials. Lab Benefit Management Program Clinical Payment and Coding Policies were posted on our Provider website as of Aug. 1, 2022. Some policies became effective Nov. 1, 2022, and other policies are effective Feb. 1, 2023 (claim edits will not initially apply to the rate at which tests have been ordered or with respect to the age or gender of a patient).

New on Our Website: Answers to Frequently Asked Questions
To help you prepare for the launch of this program, our Provider Network Consultant (PNC) team has hosted several rounds of educational webinars. Many providers offered feedback, which helped us plan for additional trainings. Recently, we added new Avalon Lab Management Program FAQs to our Claim Submission page, under the Related Resources. We hope you find this information insightful and informative.

Continue to watch the News and Updates for announcements on this program and other BCBSIL initiatives. Also be sure to join our PNC team for their monthly Provider Hot Topics webinar. Dates, times and registration links are listed on our Webinars and Workshops page. It’s a great place to connect with your PNC and stay in the loop on the latest BCBSIL news.

This program doesn’t apply at this time to government programs or any of our HMO members.

Avalon Health Solutions (Avalon) is an independent company that provides claims management services for members with coverage through BCBSIL. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services regarding third party vendors and the products and services they offer. 