CommercialAdministrativeHigh impact
Avalon Laboratory Management Program
EmblemHealth·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 will add automated post-service reviews of laboratory claims across office, hospital outpatient, and independent lab settings to ensure adherence to laboratory policies and guidelines.
Action Required
Before March 1, 2023: Billing team must review the new Laboratory Benefit Management Payment Integrity Policy and updated reimbursement policies on EmblemHealth and ConnectiCare websites. Monitor for claim denials or payment adjustments on laboratory services as Avalon begins automated post-service reviews. Ensure all laboratory claims include proper documentation to support medical necessity and adherence to updated guidelines.