Avalon Healthcare Solutions Secures Patent for Groundbreaking Lab Claims Review Technology

APEA platform recognized for transforming real-time policy enforcement and powering smarter diagnostics decisions

TAMPA, Fla., April 16, 2025 /PRNewswire/ -- Avalon Healthcare Solutions, the nation's first and only Lab Insights company, has been awarded U.S. Patent No. 12,148,534 B1 for its system and method for automated policy enforcement. Avalon leverages its proprietary technology (called APEA) that instantly reviews and enforces lab test claims against adopted health plan policies at scale.

Since its inception in 2013, Avalon has been redefining lab benefit management with technology-enabled solutions that ensure patients receive the right test at the right time for the right care. The APEA platform marks a significant milestone in Avalon's mission to modernize diagnostics management and elevate care quality through smarter, faster, and more accurate lab claims processing and policy enforcement.

"This patent validates what our clients have known for years — Avalon's technology leads the industry in speed, accuracy, and innovation," said Bill Kerr, MD, CEO of Avalon Healthcare Solutions. "APEA enables real-time, automated policy enforcement that ensures compliance and clinical appropriateness and powers the data insights that drive better outcomes and lower costs."

Automated. Scalable. Smart.

Here's how it works: When a provider submits a lab test claim, Avalon's APEA platform, which is fully integrated into health plan systems, instantly checks the claim against science-based lab policies and delivers a coverage determination in real-time. There's no delay, no manual review, and no guesswork.

Operating at enterprise scale, APEA processes over 18 million claims per month and delivers 1 million+ real-time edits per client across 40+ million managed lives nationwide. This high-performance automation dramatically reduces administrative friction while safeguarding healthcare dollars and optimizing member care.

"APEA embodies Avalon's tech-forward vision," said Lynn Mettler, CTO of Avalon. "It allows us to enforce Avalon's catalog of rigorous science-based lab policies instantly — all while enhancing operational efficiency, accelerating treatment access, and preserving providers' clinical decision-making. Our platform doesn't replace providers. It empowers them."

Innovation That Powers Lab Insights

Beyond claims adjudication and policy enforcement, Avalon's Lab Insights ecosystem is unlocking the full value of diagnostic testing. Its cloud-based, HITRUST-certified infrastructure ensures data security while enabling AI and machine learning-powered tools—including predictive analytics, explainable AI, and natural language processing—to drive proactive care strategies and streamline health plan operations.

Avalon's patented technology and intelligent insights platform support end-to-end lab diagnostics management, including:

• Policy enforcement and compliance
  
  
• NCQA-certified utilization management for genetic testing
  
  
• Test quality evaluation and new tech assessment
  
  
• Early disease detection and treatment optimization

By digitizing and analyzing lab results in real-time, Avalon helps health plans shift from reactive to proactive care — improving clinical outcomes, reducing unnecessary testing, and maximizing the impact of every healthcare dollar.

"This patent marks just the beginning," added Dr. Kerr. "We're committed to advancing diagnostics technology that supports earlier detection, more personalized treatment, and better healthcare at scale."

To learn more about how Avalon transforms lab insights into action, visit www.avalonhcs.com.

About Avalon Healthcare Solutions
Avalon Healthcare Solutions is the first and only Lab Insights company, combining lab benefit management, clinical science, and proprietary analytics to help health plans deliver more appropriate, cost-effective, and proactive care. Avalon's Lab Insights solutions capture and analyze lab results in real-time, enabling earlier detection, smarter treatment decisions, and reduced healthcare spending. Serving health plans nationwide, Avalon manages lab benefits for over 40 million lives and delivers 10–20% savings on outpatient lab costs.

Media Contacts:
Michele Norton MS, RN
SVP Product Marketing, Avalon Healthcare Solutions
[email protected]

Janet Mordecai
Amendola Communications for Avalon Healthcare Solutions
[email protected] 

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SOURCE Avalon Healthcare Solutions