New Laboratory Management Program & Related Clinical Payment and Coding Policies to Begin on May 1, 2022
You may have seen the communication that we delayed the launch of our new Laboratory Benefit Management Program with Avalon Health Solutions (Avalon). 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 Texas (BCBSTX) will implement its new program with Avalon for claims for certain outpatient laboratory services provided to many of our commercial members. This implementation includes the posting of new Clinical Payment and Coding Policies. See below for key points to help you prepare.
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
Clinical Payment and Coding Policy Updates
Review the new and revised Clinical Payment and Coding Policies listed under Lab Benefit Management Program posted to our provider website effective on May 1, 2022, related to certain laboratory services, tests and procedures.
Affected Claims
Our new program may include the following outpatient laboratory claims:
- Dates-of-service on May 1, 2022
- 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 settings are excluded from this program. Member coverage terms still apply.
Provider Resources
Beginning on May 1, 2022, you can get free access 24/7 to Avalon’s Trial Claim Advice Tool by registering on Availity® Essentials 
. It will allow you to input laboratory procedure and diagnosis codes to see, before submitting a claim, the potential outcome of your claim.
- 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 into the tool for the date of service entered, 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 the Avalon Trial Claim Advice Tool and learn more about the Laboratory Management Program. To register, select your preferred date and time from the list below:
For More Information:
Watch News and Updates for future announcements.
Avalon Health Solutions (Avalon) is an independent company that provide claims management services for members with coverage through BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Avalon.
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 BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity.
