September 2022
New Laboratory Benefit Management Program To Begin Nov. 1, 2022: Join Us for a Refresher Webinar To Prepare
As we announced on Aug. 1, 2022, beginning Nov. 1, 2022, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement 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.
We encourage you attend a free webinar to learn more about the Laboratory Benefit Management Program. These webinars will be conducted by the BCBSIL Provider Network Consultant (PNC) team. Our PNCs will give you an overview of the program, including a refresher on how to access and use the Trial Claim Advice Tool. To register now, select your preferred session date and time:
Other Reminders and Resources
Policy Updates – The Clinical Payment and Coding Policies (CPCPs) page includes a link to view Laboratory Benefit Management Program CPCPs becoming effective on Nov. 1, 2022. Policies related to certain laboratory services, tests, and procedures will be implemented using a phased approach; effective dates are indicated on each CPCP.
Affected Claims – Our new program may include outpatient laboratory claims with dates of service beginning Nov. 1, 2022, for services performed in an outpatient setting (typically office, hospital outpatient or independent laboratory).
Self-service Trial Claim Advice Tool via Availity® Essentials – Since April 1, 2022, registered Availity users have had free access to Avalon’s Trial Claim Advice Tool, which is available 24/7. This tool allows you to input laboratory procedure and diagnosis codes to better understand the potential outcome of claims. Not registered for Availity? Sign up online today, at no cost.
Laboratory services provided in an emergency room, hospital observation or hospital inpatient setting are excluded from this program. Member coverage terms still apply. Additionally, 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.
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, claims finalized through the prior business day, and applicable policies and/or guidelines.
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.