BlueCross BlueShield of South Carolina and BlueChoice HealthPlan announces Avalon Healthcare Solutions as Laboratory Benefit Manager

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan announces Avalon Healthcare Solutions as Laboratory Benefit Manager

September 29, 2015

On July 22, 2015, BlueCross® BlueShield® of South Carolina and BlueChoice HealthPlan announced that we will use Avalon Healthcare Solutions (Avalon). Avalon is an independent company that provides benefit management services on behalf of BlueCross and BlueChoice®. Avalon will administer a comprehensive suite of laboratory benefit management services to promote patients access to affordable, high-quality health care. 

Avalon is a clinically driven company that uses evidence-based medicine to develop and deploy appropriate policies and protocols for the high-volume, dynamic and complex laboratory environment. Avalon is led by the work of its academic clinical advisory board (CAB). The company provides medical policy administration services for health plans. These services allow health plans to apply the latest science in the complex laboratory space to their clinical operations. This offers additional scale and efficiency to address a rapidly changing, high-volume segment of their business. Patients and their physicians enjoy access to an expanded network of independent specialty laboratory providers. This network promotes the latest and efficient application of evidence-based clinical diagnostic testing. You can request a detailed Avalon program description through the BlueCross website at www.SouthCarolinaBlues.com and the BlueChoice website at www.BlueChoiceSC.com

We will deploy the Avalon program in phases. We will do this with educational support. This gives BlueCross and BlueChoice participating physicians the chance to become familiar with the processes. Here are some important dates: 

  • Nov. 1, 2015: We will introduce new laboratory providers to the BlueCross- approved laboratory network. We will publish a complete list of participating laboratories before Nov. 1, 2015.
  • Jan. 1, 2016: New medical policies will take effect that impact laboratory services. We will enforce preauthorization requirements for select laboratory procedures.
  • April 1, 2016: Enhanced medical policy administration, including post-service claims edits, will go into effect.

Avalon will host live webinars to describe its laboratory medical management program in detail. It will also answer physician community questions. You can register for a webinar by going to www.SouthCarolinaBlues.com and selecting Providers, and then selecting Education Center. Before the webinar dates, we will send additional reminders to your practice. We hope you will take advantage of these opportunities to better understand our new process. We will make a recorded version of these live webinars available on the websites, for future reference.  

Keep these changes in mind. If you use an out-of-network laboratory or have outpatient testing performed by a hospital, your patients’ out-of-pocket costs may be significantly higher. Some products do not have out-of-network benefits at all. To ensure the lowest cost to your patients, please send BlueCross and BlueChoice members testing to an in-network laboratory only.

The Avalon network is dedicated to providing patients with expanded access to high-quality, cost-effective laboratory testing. You can help your patients by using network laboratories. For ideal results, Avalon effectively manages the network of laboratory providers and your practice uses the laboratories accredited for network participation. 

You can find a complete participating laboratory directory at www.SouthCarolinaBlues.com and www.BlueChoiceSC.com

We look forward to working with your practice to ensure your patients receive expanded access to high-quality and affordable laboratory care. If you have questions related to this change, please do not hesitate to contact your provider education representative.

BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.