Extended Implementation Data for Laboratory Medical Policy Edits

Extended Implementation Data for Laboratory Medical Policy Edits


Good news! BlueCross® BlueShield® of South Carolina, BlueChoice HealthPlan and Avalon have extended the implementation date for the laboratory medical policy edits to Jan. 1, 2017, for hospitals (POS 22 and 19) and physician offices (POS 11). In everything we do, we always consider your concerns and work with you to meet your needs. Therefore, to allow you more time to research the pay and educate alerts on your remittance advices, update your systems, and to educate your staff, the date has been extended. The medical policy updates were implemented on Nov. 1, 2016, for independent laboratories (POS 81).

Multiple education opportunities were offered to prepare for this initiative to include group meetings, news bulletins and webinars about the Avalon Lab Benefit Management Trial Claim Tool in My Insurance Manager, to name a few.  We recommend that you begin using the Trial Claim Tool to become familiar with the requirements for laboratory tests (example: frequency limitations, gender limitations, units, etc.) to avoid future denials. Login to My Insurance Manager, select Resources, then under Tools, select Avalon Lab Benefit Management Trial Claim Tool. If your office requires additional training, please contact Provider Relations and Education by emailing provider.education@bcbssc.com.

Remember to send BlueCross and BlueChoice® members’ testing to in-network laboratories only and to always check for preauthorization requirements on genetic testing, cytogenetic testing and molecular pathology codes. BlueCross and BlueChoice expects all providers to utilize in-network laboratory resources whenever possible.

You can find more communications about Avalon, the Trial Claim Tool and a list of participating laboratories by visiting our websites at www.SouthCarolinaBlues.com and www.BlueChoiceSC.com. You may also contact Avalon at 855-895-1676 for additional information. Avalon is an independent company that provides a comprehensive suite of laboratory benefit management services on behalf of BlueCross and BlueChoice.

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