AdministrativeMedicare AdvantageJuly 1, 2025

Implementation of chargemaster‑based claims edit for ER leveling

Effective August 1, 2025, claims submitted by care providers who are reimbursed on a percentage‑of‑charge basis will undergo payment adjustments based on a customized chargemaster table. We use ER leveling to review emergency room evaluation and management (E/M) service claims for consistency with submitted claim elements. This table, specifically developed for percentage‑of‑charge care providers, will use historical claim data to determine the appropriate billed charge amount.

For questions or further clarification, please contact Provider Services via the number on the back of our member ID card.

Thank you for your cooperation and continued partnership.

Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross, Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CABC-CR-085393-25, CPN84170

PUBLICATIONS: July 2025 Provider Newsletter