MedicaidAdministrativeHigh impact
[Georgia] Avalon Policy Updates - Q3 2024
CareSource·GA · Family Medicine, Internal Medicine, OB-GYN +6 more·Medical Policy
Effective date
Apr 1, 2025
We identified it
Jun 13, 2026
Summary
CareSource Georgia Medicaid has partnered with Avalon Healthcare Solutions to implement laboratory benefits management (LBM) with routine testing management (RTM) - a post-service pre-payment clinical claim editing program. 35 laboratory policies will be updated effective April 1, 2025, affecting routine lab testing compliance and reimbursement.
Action Required
Before April 1, 2025: Billing team must review all 35 updated laboratory policies on Avalon's website to ensure compliance with new RTM program requirements. Use the Trial Claim Advice tool on CareSource Provider Portal to test lab claims for adherence before submission. Update billing workflows to accommodate post-service pre-payment clinical claim editing for routine lab tests. Non-compliance may result in claim denials or payment delays.