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