February 1, 2022
You may have seen the communication about the delayed launch of our new Laboratory Benefit Management program with Avalon Health Solutions. We delayed this launch because we required additional time to make improvements to the program.
Effective May 1, 2022, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement its new program with Avalon Healthcare Solutions for claims for certain outpatient laboratory services provided to many of our commercial, non-HMO members.
This program does not apply to government programs or any of our HMO members.
The new program will:
- Help ensure our members have access to the right care at the right time and in the right setting
- Better prepare you to submit claims that support and reflect high quality, affordable care delivery to our members
See below for key points and provider resources to help you prepare.
Policy Updates
Watch for new and revised Clinical Payment and Coding Policies effective on May 1, 2022, related to certain laboratory services, tests and procedures.
Affected Claims
Our new program may include:
- Outpatient laboratory claims with dates of service beginning May 1, 2022
- Claims for services performed in an outpatient setting (typically office, hospital outpatient or independent laboratory)
Note: Laboratory services provided in an emergency room, hospital observation or hospital inpatient setting are excluded from this program. Member coverage terms still apply.
Self-service Trial Claim Advice Tool via Availity® Essentials
Beginning on May 1, 2022, registered Availity users can get free access to Avalon’s Trial Claim Advice Tool, which is available 24/7. This tool allows you to input laboratory procedure and diagnosis codes to see, before submitting a claim, the potential outcome of your claim. Not registered for Availity? Sign up online today 
, at no cost.
Note: The Trial Claim Advice Tool does not guarantee approval, coverage, or reimbursement for health care services. Potential claim outcomes provided by Avalon’s Trial Claim Advice Tool consider information entered in the tool for the date of service entered and historical claims finalized through the prior business day and may link to applicable policies and/or guidelines.
Provider Training
Attend free webinars on how to use Avalon’s Trial Claim Advice Tool and learn more about the Laboratory Benefit Management Program. To register, select your preferred date and time from the list below:
For More Information
Continue to watch News and Updates for future program updates.
This program does not apply to government programs or any of our HMO members.
Avalon Health Solutions (Avalon) is an independent company that provide claims management services for members with coverage through BCBSIL. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Avalon or Availity.