CommercialAdministrativeHigh impact
Laboratory Benefit Management
EmblemHealth·Pathology·Provider News
Effective date
Mar 1, 2023
We identified it
Jun 20, 2026
Summary
EmblemHealth and ConnectiCare are implementing a new Laboratory Benefit Management program with Avalon Healthcare Solutions starting March 1, 2023. This program will affect reimbursement and management of laboratory services, tests, and procedures.
Action Required
Before March 1, 2023: Billing team must review the new Laboratory Benefit Management Payment Integrity Policy on EmblemHealth and ConnectiCare websites to understand impacted laboratory services and updated reimbursement policies. Update billing procedures for laboratory claims according to the new LBM program requirements to ensure proper reimbursement.