MedicaidAdministrativeMedium impact
[Georgia] Avalon Policy Update - Colorectal Cancer Screening
CareSource·GA · Gastroenterology, Internal Medicine, Family Medicine +1 more·Medical Policy
Effective date
Sep 1, 2025
We identified it
May 9, 2026
Summary
CareSource has implemented a new laboratory benefits management partnership with Avalon Healthcare Solutions for Georgia Medicaid, introducing a Routine Testing Management (RTM) program effective September 1, 2025. This post-service pre-payment clinical claim editing program will review colorectal cancer screening laboratory claims for compliance with Avalon's lab policies. Billing teams must familiarize themselves with the updated G2181 policy and use the Trial Claim Advice Tool to validate claims before submission.
Action Required
By August 31, 2025: Billing team must (1) access and review the full G2181 Colorectal Cancer Screening policy on Avalon's website to identify specific coverage and documentation requirements; (2) register for and test the Trial Claim Advice Tool on the CareSource Provider Portal to validate colorectal cancer screening laboratory claims before submission; (3) update internal billing guidelines and staff training to reflect new RTM program requirements for Georgia Medicaid claims; (4) implement a pre-submission review process for all colorectal cancer screening laboratory claims to ensure compliance with Avalon policies. Failure to comply with RTM requirements may result in post-service claim denials or payment recoupment.