Starting Oct. 1, 2024, EmblemHealth will expand our current Laboratory Benefit Management (LBM) program with Avalon Healthcare Solutions (Avalon) to our HMO and PPO (non-City of New York) Commercial, Medicare, and Medicaid plans.
Avalon already reviews laboratory services for other EmblemHealth and ConnectiCare members when performed in office, hospital outpatient, and independent laboratory settings reported on claims (post-service and pre-payment).
In support of this program, the Laboratory Benefit Management Payment Integrity Policy details the program components, including impacted laboratory services, tests, and procedures. It also includes a section of anticipated frequently asked questions (FAQs). To provide transparency regarding this program and the review standards that will be used, we have reimbursement policies designated (LBM) that are being updated to reflect the program’s expansion to the EmblemHealth plans indicated above.
If you are not already familiar with this program, we recommend reviewing this Laboratory Benefit Management Program Provider Training Guide.
