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New Laboratory Policies and Claim Simulation Tool Coming Jan. 1, 2022: Join Us for A Webinar to Prepare

Posted November 29, 2021

As we announced in September 2021, beginning Jan. 1, 2022, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement new policies and a new program for claims for certain outpatient laboratory services provided to our fully insured commercial non-HMO members. This program does not apply to government programs or any of our HMO members.

The new Laboratory Management Program will include outpatient laboratory claims performed in an outpatient setting (typically office, hospital outpatient or independent laboratory) with dates-of-service on or after Jan. 1, 2022. (Note: Laboratory services provided in emergency room, hospital observation and hospital inpatient settings are excluded from this program. Member contract benefits and clinical criteria still apply.)

Effective Jan. 1, 2022, registered Availity® users can get free access to the program’s Trial Claim Advice Tool. This tool allows you to input codes and diagnoses to see, before submitting a claim, the potential outcome of your claim. To get to the Trial Claim Advice Tool, you’ll use the single sign-on feature via the BCBSIL-branded Payer Spaces section within the Availity® Provider Portal.

Provider Training
We encourage you attend a free webinar to learn more about the Laboratory Management Program, including how to use the Trial Claim Advice Tool. To sign up, select your preferred date and time from the list below:

Not registered with Availity?
Be sure to become a registered Availity user before the January 2022 Laboratory Management Program activation, so that you can access the Trail Claim Advice Tool. Register on the Availity website  today, at no charge. For registration help, call Availity Client Services at 800-282-4548.

For More Information
Watch for new and revised BCBSIL Medical Policies effective Jan. 1, 2022, related to certain laboratory, services, tests, and procedures. Also refer to our Clinical Payment and Coding Policies, and continue to watch the News and Updates for future program updates.

This program does not apply to government programs or any of our HMO members.

The Trial Claim Advice Tool is a free simulation tool and does not guarantee approval, coverage or reimbursement of services. Responses consider information entered through the tool for the date of service entered and historical claims finalized through the previous business day. Claims not yet finalized won’t be considered.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity.