Lab Insights Solutions
Routine Test Management
Routine lab testing is anything but routine.
Over 13 billion clinical lab tests are performed each year, making it the #1 utilized medical benefit.1
Routine tests represent 99% of all lab testing and the majority of the lab testing dollars.2
Approximately 30% of lab tests are unnecessary. Ordering tests that are clinically not indicated sometimes lead to additional downstream healthcare costs.3
These factors make it critical for health plans to focus on their lab benefit to ensure that the right testing is done, that removal of waste and abuse occurs, and make sure clinicians implement the right treatment based on the lab results.
Avalon’s Routine Test Management solution offers you automated software to ensure lab testing follows guidelines from scientific lab policies resulting in proven cost savings.
This is powered by its automated lab policy adherence software to evaluate laboratory claims post-service and pre-payment in near real time. The proprietary software uses thousands of rules that compare CPT and ICD 10 codes, age, lab test history and frequency to ensure that lab tests are appropriate for the clinical condition and consistent with the health plan policies. As Avalon’s Routine Test Management solution occurs post service, there is no disruption or abrasion to the physician or patient.