CommercialAdministrativeHigh impact
More Members in Avalon Lab Program Oct. 1
EmblemHealth·Provider News
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
EmblemHealth is expanding its Laboratory Benefit Management program with Avalon Healthcare Solutions to include HMO and PPO Commercial, Medicare, and Medicaid plans starting October 1, 2024. This will subject laboratory services performed in office, hospital outpatient, and independent lab settings to additional post-service review and pre-payment scrutiny.
Action Required
By October 1, 2024: Billing team must review the Laboratory Benefit Management Payment Integrity Policy and Provider Training Guide to understand new review standards for lab claims. Update billing workflows to account for potential post-service reviews and pre-payment scrutiny of laboratory services for EmblemHealth HMO/PPO Commercial, Medicare, and Medicaid plans. Monitor reimbursement policies marked (LBM) for specific requirements that may affect claim processing and payment timing.