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Use Case

Gold Carding and Prior Authorization Relief for Labs

How Avalon’s performance-based model reduces admin work and speeds approvals.

Proven Impact

Avalon

Avalon’s Approach

Avalon’s Gold Carding Program, part of the AvalonSelect Genetic Network (ASGN), transforms PA from a blanket requirement to a performance-based privilege. Labs that meet specific performance thresholds benefit from:

  • PA exemption for qualifying tests based on utilization and approval data
  • Ongoing performance monitoring through monthly and quarterly audits using NCQA methodology
  • Real-time performance feedback through lab-specific quality reporting and claims data review

This model rewards excellence, accelerates processing, and improves the provider experience for top-tier labs.

Proven Impact

Genetic testing labs with a national footprint that join the AvalonSelect Genetic Network, maintain a >90% approval rate on prior authorizations across key procedures, and participate in Avalon’s Gold Card Quality Audit Process are eligible to:

Gain PA exemption for 22 high-volume CPT codes

Reduce the average test turnaround time by 3.5 days

Decrease internal admin resource allocation to PA by 30%

Experience a drop in appeals and denials, improving payer-lab collaboration

The lab gold card designation is reviewed quarterly, and continuous adherence will be confirmed via monthly utilization and variance tracking.

Key Capabilities Used

Impact

  • Reduce PA-related workload
  • Faster test processing, boosting provider satisfaction and lab competitiveness
  • Fewer appeals and denials, improving claim lifecycle
  • Higher throughput and revenue predictability
  • Clear performance benchmarks driving continuous quality improvement

Your quality should speak for itself. Let it.

Contact us to join our Gold Carding Program or get evaluated for PA relief.

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