Important reminder regarding member ID submission requirements for Avalon Claims

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Avalon Healthcare Solutions (Avalon) have identified an increase in laboratory claim rejections due to incomplete member identification information submitted on claims. Submission requirements have not changed; however, including the complete member identification number remains essential for accurate claims processing.

To ensure timely and accurate claims processing, participating laboratory providers should verify that the entire member identification number, including the suffix, is submitted on all claims sent to Avalon. The member suffix is a required component of the member identification number and helps ensure accurate member matching and claim processing. Omitting the suffix may result in claim rejections, processing delays, payment delays, and the need for claim correction and resubmission.

While all member identification numbers should be submitted in full, this issue has been most frequently identified on claims involving certain member products, including Brighton members. Brighton member suffixes must be included as part of the member identification number submitted on the claim. Below is a sample Brighton member ID card:

Including the complete member identification number helps support accurate member matching, reduce claim rejections, and promote timely claims processing and payment.

Questions

Providers with questions regarding claim submission requirements should contact Avalon Healthcare Solutions through their normal provider support channels. Thank you for your partnership and attention to this important claims submission requirement.