2017 Update: Laboratory Medical Policy Edits

2017 Update: Laboratory Medical Policy Edits

3/24/2017

On April 1, 2017, BlueCross BlueShield of South Carolina, BlueChoice® HealthPlan and Avalon Healthcare Solutions (Avalon) are expanding the laboratory medical policy edits to include all places of service (POS), except for inpatient hospitals and emergency rooms.  Avalon is an independent company that provides benefit management services on behalf of BlueCross and BlueChoice® and administers a comprehensive suite of laboratory benefit management services to promote patients access to affordable, high-quality health care. 
 
As a reminder, laboratory medical policy edits were implemented on Nov. 1, 2016, for independent laboratories (POS 81) and on Jan. 1, 2017, for laboratory services done in a physician’s office (POS 11). 
 
What you should do:
 
Multiple education opportunities were offered to prepare for this program initiative including group meetings, news bulletins, webinars and presentations by Avalon at our year end benefit update meetings, and clinical meetings for laboratory ordering physicians and practice clinicians. In effort to avoid future claim denials, we recommend that you begin using the Avalon Trial Claim Tool to become familiar with the requirements for laboratory tests (example: frequency limitations, gender limitations, units, etc.).  
  • Log in 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. 
  • 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 or visit their website at www.avalonhcs.com for additional information. 
 
BlueChoice HealthPlan of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.