Oct. 30, 2025
Effective Jan. 1, 2026, we’ll offer our laboratory claims review program for routine outpatient laboratory services provided to more of our commercial members.
In addition to our fully insured members, beginning Jan. 1, 2026, our Administrative Services Only members will now be eligible for review of:
- Outpatient laboratory claims with dates of service beginning Jan. 1, 2026
- Claims for services performed in an outpatient setting (typically office, hospital outpatient or independent laboratory)
- Any claims that meet criteria relevant to one or more of the applicable laboratory services
Beginning on or after Jan. 1, 2026, our reimbursement policies will apply to certain ASO members. View our Laboratory Management Coding and Compensation Policies in Availity® Essentials by using the Plan Documents Viewer application in the Payer Spaces for Blue Cross and Blue Shield of Montana.
Estimate coverage for your lab claims with Avalon: Avalon Healthcare Solution’s Trial Claim Advice Tool can give you an estimate of how your lab claim may be reviewed based on the input of procedure and diagnoses codes.
Available at no cost via Availity Essentials, the self-service tool uses information entered for the date of service and historical claims finalized through the previous business day. Claims not yet finalized won’t be included.
To access the Trial Claim Advice Tool:
- Log in to Availity Essentials.
- Select Payer Spaces from the main navigation menu and choose BCBSMT.
- Within Payer Spaces, select Avalon under the Applications tab.
- You’ll be redirected to the Trial Claim Advice Tool.
This program doesn’t apply to government programs at this time.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT.
Avalon Healthcare Solutions is an independent company that provides claims management services for members with coverage through BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding any products or services regarding third party vendors and the products and services they offer.