Sept. 24, 2025
Effective Jan. 1, 2026, our laboratory benefit management program will apply to certain commercial, non-HMO Administrative Services Only (ASO) group claims.
New Clinical Payment and Coding Policies, posted on October 1, 2025, will apply to certain commercial non-HMO ASO claims for laboratory services with dates of service beginning Jan. 1, 2026.
These policies apply to certain ASO group outpatient laboratory claims (typically performed in an office, hospital outpatient, or independent laboratory setting). These policies do not apply to laboratory services provided in an emergency room, hospital observation or hospital inpatient setting.
View our Laboratory Management Clinical Payment and Coding policies to become familiar with the criteria and the ASO group claims to which the policies will apply ahead of the Jan. 1, 2026 implementation date.
This program doesn’t apply at this time to IL fully-insured, government programs (Medicare Advantage and Illinois Medicaid) or any of our HMO claims.
Avalon Healthcare Solutions is an independent company that provides claims management services for members with coverage through Blue Cross and Blue Shield of Illinois.
BCBSIL makes no endorsement, representations or warranties regarding any products or services regarding third party vendors and the products and services they offer.