Avalon’s Laboratory Benefit Management Program

The Expert in Laboratory & Medical Specialty Drug Benefit Management

We make managing laboratory services effective and efficient

Routine Test Management

  • $1.50 - $2.00 PMPM annual savings achieved through automated policy enforcement
  • Allows review of high-volume, low-cost claims, the greatest source of plan savings unachievable without automation
  • "Low-value care” reimbursement is minimized
  • No plan configuration/maintenance

Genetic Test Management

  • $0.40 - $0.55 PMPM​ annual savings
  • Addresses genetic testing ordering and coding reimbursement complexities
  • Pre-service review based program focused on provider education
  • Reduces cost without reduction in quality
  • No plan configuration/maintenance
  • Increases provider satisfaction

A Client's Perspective on Avalon

…our relationship [with Avalon] has resulted in significant savings for our health plan and our customers. We could not be more pleased with the results provided with the implementation of the program.

        ~ Martha Owens Perry
              Vice President - Health Care Service
              BlueCross BlueShield South Carolina

Independent Laboratory Network Management

  • 1% to 5% network unit costs reduction
  • Plan specific network designs including genetic provider wraps
  • Emerging technology consultation
  • Reduces plan administrative burden

Medical Specialty Rx Management

  • $1.00- $2.00 PMPM savings
  • Addresses current gaps in Medical Specialty reimbursement processes including PA matching logic
  • Identifies provider non-compliance with plan policy
  • Aids Fraud, Waste, and Abuse identification and detection

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