CommercialCoverageHigh impact
AB2026-05-001 Updates and new information
Capital Blue Cross·Provider News
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Capital Blue Cross is transitioning from Avalon to direct contracts with independent laboratories and implementing EviCore's Clinical Guidelines for Lab Management Program version 2.0.2026. This affects all laboratory billing with new medical policy enforcement through claims adjudication and introduces 44 new clinical guidelines while retiring 13 existing ones.
Action Required
By June 30, 2026: Billing team must review and implement EviCore's Clinical Guidelines for Lab Management Program version 2.0.2026 available on Capital's medical policies page. Update billing procedures to ensure all laboratory services meet new medical policy criteria as non-compliant services will be denied during claims adjudication. Verify that laboratory providers are participating in Capital's new direct contract network as Avalon network will no longer be accepted after June 30, 2026.