Laboratory Benefit Management Program
Starting March 1, 2023, EmblemHealth and ConnectiCare will implement a new Laboratory Benefit Management (LBM) program in collaboration with Avalon Healthcare Solutions. The new Laboratory Benefit Management Payment Integrity Policy details the program components, including impacted laboratory services, tests, and procedures. It also includes a section of anticipated frequently asked questions (FAQs).
The program’s reimbursement policies are on our websites and are available for your review. If you receive a claim denial, the message will provide this website address, bit.ly/Our-RP, as a shortcut to the policies. Look for the applicable test to see why the claim denied. It will be tagged “(LBM)”. The same policies may be found on both of our sites:
- EmblemHealth: Reimbursement Policies.
- ConnectiCare: Reimbursement Policies.
Bundled Services Reimbursement Policy
New codes go into effect starting March 1, 2023 for our Bundled Services Reimbursement Policy (Commercial and Medicare). These apply to both EmblemHealth and ConnectiCare. See policy’s Revision History for the new codes.
