Laboratory Medical Policy Edits

Laboratory Medical Policy Edits


Avalon Healthcare Solutions partnered with BlueCross® BlueShield® of South Carolina and BlueChoice HealthPlan to administer laboratory benefits management services to promote patient access to affordable, high quality health care. As a reminder, as of Jan. 1, 2017, laboratory services done in a physician’s office (place of service 11) that do not meet medical policy criteria may be denied.

Multiple education opportunities were offered to prepare for this initiative including group meetings, news bulletins, webinars and presentations by Avalon at our year end benefit update meetings. 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.) 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

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 and  You may also contact Avalon at 855-895-1676 or visit their website at for additional information.

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