Blue Cross and Blue Shield of North Carolina (Blue Cross NC) reminds providers that Avalon Healthcare Solutions (Avalon) manages the exclusive network of independent reference laboratories for our commercially-insured and administered products. Only laboratories contracted with Avalon are eligible to provide in-network laboratory services and receive payments under our members' in-network benefits.
If your health care organization makes referrals for patients' laboratory tests and services, please review the participating laboratory list to find an eligible, in-network laboratory location.
Please remember
- Your patients with Blue Cross NC coverage depend on participating providers' use of in-network laboratories.
- Patients have the lowest out-of-pocket costs when in-network services are obtained.
- Blue Cross NC requires pre-certification from Avalon for certain laboratory services, tests, and procedures, in advance (pre-service) of being performed in an office, hospital outpatient, or independent laboratory location.
- A list of the specific laboratory services, tests, and procedures requiring pre-certification is available on the Prior Plan Review page.
- Laboratory referrals for our commercially-insured and administrative services only (ASO) members, as well as BlueCard® members receiving services in North Carolina, are required to be sent to in-network laboratories.
- However, Avalon's pre-certification requirements do not apply to BlueCard members with coverage through other Blue Plans. (Please remember to always check with each patient's Home Plan about specific pre-certification requirements.)
