Policy UpdatesMedicaidJune 20, 2024

Facility emergency department leveling reviews for providers under investigation

Effective September 1, 2024, Anthem will implement facility emergency department leveling.

Facilities must use appropriate codes and leveling for all services furnished during the emergency department (ED) encounter. The highest intervention/resource used determines the final facility ED level, which the Special Investigations (SIU) Prepayment Review team assesses for care providers under investigation who are also participating in the prepayment review program.

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Availity Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials, go to Availity.com, select state and the appropriate payer space tile from the drop-down. Then, select Chat with Payer and complete the pre-chat form to start your chat.

For additional support, visit the Contact Us section on our care provider website for the appropriate contact.

Please note: This policy does not apply for providers using the enhanced ambulatory patient grouping (EAPG) pricing methodology.

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Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: July 2024 Provider Newsletter