New Laboratory Policies Coming Jan. 1, 2022

September 30, 2021

Beginning Jan. 1, 2022, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement new policies and a new program for claims for certain outpatient laboratory services provided to our Fully Insured commercial, non-HMO members. Our New Laboratory Management Program will help ensure our members get the right care at the right time and in the right setting. It will also help you better prepare and submit claims that support and reflect high quality, affordable care delivery to our members.

This program does not apply to government programs or any of our HMO members.

See below for key points to help you prepare, including a list of training dates.

Medical Policy Updates
Watch for new and revised reimbursement and BCBSIL Medical Policies effective Jan. 1, 2022, related to certain laboratory services, tests and procedures. Also refer to our Clinical Payment and Coding Policies.

Affected Claims
Our new program will include the following outpatient laboratory claims:

  • Dates-of-service on or after Jan. 1, 2022
  • Performed in an outpatient setting (typically office, hospital outpatient or independent laboratory)

Note: Laboratory services provided in emergency room, hospital observation and hospital inpatient settings are excluded from this program. Member contract benefits and clinical criteria still apply.

New Claim Simulation Tool
Effective Jan. 1, 2022, you can get free access to the program’s Trial Claim Advice Tool, which allows you to input codes and diagnoses to see, before submitting a claim, the potential outcome of your claim. The Trial Claim Advice Tool is a free simulation tool and does not guarantee approval, coverage or reimbursement of services. Responses consider information entered through the tool for the date of service entered and historical claims finalized through the previous business day. Claims not yet finalized won’t be considered.

What you need to do:

  • To access the Trial Claim Advice Tool, log on to the Availity® Provider Portal
  • To get to the Trial Claim Advice Tool, use the single sign-on feature via the BCBSIL-branded Payer Spaces section within the Availity portal.
  • If you’re not a registered Availity user, we encourage you to sign up before the January 2022 program activation, to gain access to the Trial Claim Advice Tool. Register on the Availity website  today, at no charge. For registration help, call Availity Client Services at 800-282-4548.

Provider Training
Attend free webinars on how to use the 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
Continue to watch the News and Updates for future program updates.

This program does not apply to government programs or any of our HMO members.

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 Availity.