Jan. 5, 2022 Update: This communication has been reposted to provide an updated participating laboratory list. The communication was originally posted on March 31, 2021.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) reminds providers that Avalon Healthcare Solutions (Avalon) manages the network of independent reference laboratories for the majority of our commercially insured and administered products. 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 (PDF) 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.)
