Blue Review
A Provider Publication

March 2022

New Laboratory Management Program To Begin on May 1, 2022

You may have seen the communication about the launch of our new Laboratory Benefit Management program with Avalon Health Solutions. We delayed this launch because we made improvements to the program.

On May 1, 2022, Blue Cross and Blue Shield of Illinois (BCBSIL) will launch its new program with Avalon Healthcare Solutions for claims for certain outpatient laboratory services provided to many of our commercial, non-HMO members. 

This program does not apply to government programs or any of our HMO members.

The new program will:

  • Help ensure our members have access to the right care at the right time and in the right setting
  • Better prepare you to submit claims that support and reflect high quality, affordable care delivery to our members

See below for key points and provider resources to help you prepare.

Policy Updates
Watch for new and revised Clinical Payment and Coding Policies effective on May 1, 2022, related to certain laboratory services, tests and procedures.

Affected Claims
Our new program may include:

  • Outpatient laboratory claims with dates of service beginning May 1, 2022
  • Claims for services performed in an outpatient setting (typically office, hospital outpatient or independent laboratory)

Note: Laboratory services provided in an emergency room, hospital observation or hospital inpatient setting are excluded from this program. Member coverage terms still apply.

Self-service Trial Claim Advice Tool via Availity® Essentials

Beginning on May 1, 2022, registered Availity users can get free access to Avalon’s Trial Claim Advice Tool, which is available 24/7. This tool allows you to enter laboratory procedure and diagnosis codes to see – before submitting a claim – the potential outcome of your claim. Not registered for Availity? Sign up online today, at no cost.

Note: The Trial Claim Advice Tool does not guarantee approval, coverage, or reimbursement for health care services. Potential claim outcomes provided by Avalon’s Trial Claim Advice Tool consider information entered in the tool for the date of service entered and historical claims finalized through the prior business day and may link to applicable policies and/or guidelines.

Provider Training
Attend free webinars on how to use Avalon’s Trial Claim Advice Tool and learn more about the Laboratory Benefit Management program. To register, select your preferred date and time from the list below:

For More Information
Continue to watch News and Updates for future program updates.

This program does not apply to government programs or any of our HMO members.