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Blue Choice

Laboratory Benefits Management

Learn about the goals of our Laboratory Medical Benefits program by reading about our relationship with Avalon Healthcare Solutions. Avalon is an independent company that provides benefits management service on behalf of BlueCross and BlueChoice. 

Medical Policies and Clinical Guidelines
Access our policies and guidelines to stay up to date on BlueChoice coverage, as well as national experts' recommendations.

Use our Laboratory Summary: Common Medical Policy Edits as a quick reference for specific medical policy guidelines for certain laboratory services.  

Learn which lab services require prior authorization by Avalon prior to performing the services and how to get prior authorizations.
  • 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. 
  • Preview the 2018 Lab Procedure Authorization Matrix
  • Complete this form to request prior authorizations for specific lab services.

Network Laboratories
View a list of the current BlueCross, BlueChoice and Avalon participating laboratory providers.

Resources and Forms
BlueChoice has several online educational resources that describe the laboratory medical management program in detail. The most commonly used resources are: past webinars, provider news, frequently asked questions and user guides. 

You can also use the Laboratory Reconsideration Form as a cover transmittal sheet if you have additional documentation that supports reversal of a claim adjudication. 

If you have questions or would like to learn more, you can contact the Provider Education department by using the Provider Education Contact Form. You can also request training by using the Provider Advocate Training Request Form.  

Other Resources: