BCBS Michigan – Laboratory Claims Editing Coming to Blue Cross Commercial and Medicare Plus Blue

Starting in June 2022, Blue Cross Blue Shield of Michigan will be implementing a laboratory benefits management program, supported by Avalon Healthcare Solutions, for Blue Cross commercial and Medicare Plus Blue℠ claims. Avalon is an independent company that contracts with Blue Cross Blue Shield of Michigan to provide laboratory benefits management.

Avalon’s automated policy enforcement (post-service) edits will be applied to claims reporting laboratory services performed in office, hospital outpatient and independent laboratory locations. Laboratory services, tests and procedures provided in emergency department, hospital observation and hospital inpatient settings are excluded from this program.

Source: https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/the_record/2022/may/Record_0522i.shtml