Laboratory Benefit Management Program: Reminders and Resources

January 31, 2023

In November 2022, we launched our Laboratory Benefit Management program with Avalon Healthcare Solutions for certain outpatient laboratory services provided to many of our commercial, non-HMO members. 

The Laboratory Benefit Management program applies to commercial outpatient laboratory claims (typically performed in an office, hospital outpatient, or independent laboratory setting) with dates of service beginning Nov. 1, 2022. Laboratory services provided in an emergency room, hospital observation or hospital inpatient setting are excluded from this program. Member coverage terms still apply. 

  • Lab Benefit Management Program Clinical Payment and Coding Policies were posted on our Provider website as of Aug. 1, 2022. Some policies became effective Nov. 1, 2022, and other policies will become effective Feb. 1, 2023.
  • A Trial Claim Advice tool is available to registered users on Availity® Essentials.
  • Avalon Lab Management Program FAQs are available on our Claim Submission page, under the Related Resources. 

Continue to watch the News and Updates for announcements on this program and other BCBSIL initiatives. Also be sure to join our Provider Network Consultant (PNC) team for their monthly Provider Hot Topics webinar. Dates, times and registration links are listed on our Webinars and Workshops page. It’s a great place to connect with your PNC and stay in the loop on the latest BCBSIL news.


The Laboratory Benefit Management Program doesn’t apply at this time to government programs or any of our HMO members.

Avalon Health Solutions (Avalon) is an independent company that provides 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 regarding third party vendors and the products and services they offer.