Avalon Laboratory Benefit Management
Effective Nov. 1, 2022, Blue Cross and Blue Shield of Montana implemented its laboratory benefit management program with Avalon Health Solutions for claims for certain outpatient laboratory services provided to many of our commercial members in Montana.
Policies
Current Laboratory Benefit Management Coding and Compensation Policies are accessible in Availity® Essentials by using the Plan Documents Viewer application in the payer spaces for BCBSMT.
Eligibility
Laboratory Benefit Management Coding and Compensation Policies apply to all fully insured lines of business effective Nov. 1, 2022. Effective Jan.1, 2026, they also apply to certain administrative services only groups.
Trial Claim Advice Tool
The Trial Claim Advice Tool allows providers to input the procedure codes and diagnoses to view a preliminary determination of how the claim may be reviewed. The Trial Claim Advice Tool does not guarantee approval, coverage or reimbursement of services.
How to access
- To access the Trial Claim Advice Tool, log on to Availity Essentials.
- To get to the Trial Claim Advice Tool, use the single sign-on feature via the BCBS-branded Payer Spaces section in Availity.
If you’re not a registered Availity user, register on the Availity website at no charge. For registration help, call Availity Client Services at 800-282-4548.
Additional Resources
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. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.