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CareSourceMedicaid · Administrative · Medical Policy · GA · Family Medicine, Internal Medicine, OB-GYN +6 moreHigh impact

[Georgia] Avalon Policy Updates - Q3 2024

Effective date
Apr 1, 2025
Identified
Jun 13, 2026

Summary

CareSource Georgia Medicaid has partnered with Avalon Healthcare Solutions to implement laboratory benefits management (LBM) with routine testing management (RTM) - a post-service pre-payment clinical claim editing program. 35 laboratory policies will be updated effective April 1, 2025, affecting routine lab testing compliance and reimbursement.

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What to do

Action · 4 steps
01Before April 1, 2025: Billing team must review all 35 updated laboratory policies on Avalon's website to ensure compliance with new RTM program requirements.
02Use the Trial Claim Advice tool on CareSource Provider Portal to test lab claims for adherence before submission.
03Update billing workflows to accommodate post-service pre-payment clinical claim editing for routine lab tests.
04Non-compliance may result in claim denials or payment delays.

Original notice

[Georgia] Avalon Policy Updates - Q3 2024
caresource.com · Always check the source before changing claims.
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Related changes

See all CareSource changes →
[Ohio] Avalon Policy UpdatesHighEffective Dec 1, 2026 · Medical Policy[Ohio] Avalon Q3 Policy Update - February 2025HighEffective Apr 1, 2025 · Medical Policy[Ohio] Avalon Policy Update - February 2025MediumEffective Apr 1, 2025 · Medical Policy[Georgia] Avalon Policy Updates - November 2025MediumEffective Jan 1, 2026 · Medical PolicyBrowse every CareSource change in the policy list

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