Laboratory Medical Benefits
We are dedicated to ensuring your patients receive the highest quality laboratory testing at the most reasonable cost. We can only accomplish this if we effectively manage the network of laboratory providers and if your practice accesses the laboratories that have been accredited for participation in the health plan.
Sometimes patients may need a specialized test. BlueCross BlueShield of South Carolina has considered this issue and has included specialty labs and centers of excellence within the network of laboratory providers. The centers of excellence are staffed by qualified clinical pathologists and genetic counselors prepared to answer your inquiries both before and after you perform testing.
Please note that Avalon doesn't manage services in an emergency room or hospital inpatient setting. This change does not alter the available member benefits, but using these participating providers will result in a lower out-of-pocket cost for your BlueCross and BlueChoice-covered patients. Avalon is an independent company that manages lab benefits on behalf of BlueCross BlueShield of South Carolina.
As lab technology continues to become more complex and costly, it’s more important than ever that we make sure lab services meet criteria for coverage under our member’s benefit plans before services are rendered. Our relationship with Avalon allows us to do just that.
Which laboratory services require prior authorization?
Avalon conducts pre-service coverage reviews for select laboratory services performed in a doctor’s office, independent lab or outpatient setting. They don’t review for services provided in an inpatient or emergency setting.
To see which services are included, please reference the most current Avalon Prior Authorization List. You can also view which codes may automatically approve and request prior authorizations through Avalon's PAS portal on their website. If you do not have an account for the portal, you can request one here.
Note: All required criteria would need to be submitted with these requests to be auto approved.
View previous lists:
- 2023 Q1 Lab Procedure Authorization Matrix
- 2022 Q3 Lab Procedure Authorization Matrix
- 2021 Q2 Lab Procedure Authorization Matrix
Submitting Your Request
Complete Avalon Preauthorization Request Form and fax it along with any supporting documentation to 813-751-3760. Avalon will promptly review your request and provide a timely written decision.
Avalon’s Laboratory Network
Avalon also manages a network of labs. Our members pay less out of pocket when you use network labs than for non-network labs. So, we urge you to use participating laboratories, when possible.
Interested in enrolling in our lab network? Go to the Avalon website to get started. This link leads to a third party site. That company is solely responsible for the contents and privacy policies on its site.
BlueChoice® HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association.