Highmark Laboratory Operational Policies

Highmark is working with Avalon Healthcare Solutions for laboratory oversight. The laboratory testing policies are accessible through the links below. Application of criteria is dependent upon an individual’s plan at the time of the request. If there is a conflict between this Policy and any relevant, applicable government policy [e.g. Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs) for Medicare] for a particular member, then the government policy will be used to make the determination.

These policies will be applicable in PA, DE, NY and WV for Commercial and Medicare Advantage business.

 

Avalon Healthcare Solutions is a separate company that recommends pre-payment claim edits according to the laboratory testing policies adopted by its customers. Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life Insurance Company, Highmark Care Benefits Inc. or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit https://www.highmarkbcbswv.com/networkaccessplan to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.