Effective Jan. 1, 2016, BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina will require Avalon Healthcare Solutions to precertify certain lab procedures when performed in an office, outpatient or independent lab location. Avalon is an independent company that provides benefit management services on behalf of BlueCross and BlueChoice®. Please check this page frequently for new information.
What Physicians Need to Know About Avalon
Beginning Jan. 1, 2016, we will introduce a program that will improve the quality and reduce the cost of laboratory services our members receive. Note that with this new program, certain lab procedures when performed in an office, outpatient or independent lab location will require precertification.
Why Did BlueChoice Make This Change?
The cost of health care is rising for everyone and we have an obligation to ensure that our members receive the highest quality of care at the most affordable cost. Laboratory medicine is continuing to become increasingly complex. As technology improves, the cost and utilization of these services increase. This program will assist us in ensuring appropriate testing for our members at the lowest out-of-pocket cost.
How Does This Program Affect You?
We are dedicated to ensuring your patients receive the highest quality laboratory testing at the most reasonable cost. We can only accomplish this if we effectively manage the network of laboratory providers and if your practice accesses the laboratories that have been accredited for participation in the health plan.
Sometimes patients may need a specialized test. BlueChoice has considered this issue and has included specialty labs and centers of excellence within the network of laboratory providers. The centers of excellence are staffed by qualified clinical pathologists and genetic counselors prepared to answer your inquiries both before and after you perform testing.
We do not qualify all laboratories. If an out-of-network laboratory services you or you have outpatient testing performed by a hospital, your patients’ out-of-pocket cost may be significant. To ensure the lowest cost to your patients, please send BlueCross and BlueChoice members’ testing to in-network laboratories only.
Avalon has developed a Lab Procedure Authorization matrix in an effort to help you determine when you need to contact Avalon for precertification. You can submit requests for precertification by fax or by phone. Avalon will promptly review your request and provide a timely, written decision.
Please note that Avalon doesn't manage services in an emergency room, observation room, surgery center or hospital inpatient setting. This change does not alter the available member benefits, but using these participating providers will result in a lower out-of-pocket cost for your BlueCross- and BlueChoice-covered patients.
How Do You Contact Avalon?
You can send prior authorization requests to Avalon by completing the Preauthorization Request Form, by calling 844-227-5769 or by faxing 888-791-2181.
Which Laboratories are In-network?
View a comprehensive list of the independent laboratories that are in-network. You can also use our Doctor & Hospital Finder to find participating labs.
What Other Resources are Available to Assist Me in Learning More About Avalon? Here are reference materials about Avalon:
BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.