February 3, 2022
You may have seen the communication that we delayed the 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 New Mexico (BCBSNM) will implement its new program with Avalon Healthcare Solutions for claims for certain outpatient laboratory services provided to many of our commercial members.
This program does not apply to government programs.
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 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 the following outpatient laboratory claims:
- Dates-of-service beginning 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
Self-service Trial Claim Advice Tool via Availity® available 24/7
Beginning on May 1, 2022, you can get free access to the Avalon’s Trial Claim Advice Tool by registering at Availity.com , which 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 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 more information.
Avalon Health Solutions (Avalon) is an independent company that provide claims management services for members with coverage through BCBSNM. BCBSNM 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 BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity.