Reimbursement Policy update – effective May 1, 2021

Currently, Anthem Blue Cross (Anthem) allows reimbursement for applicable services for a covered member prior to admission to an inpatient hospital (referred to as the payment window) unless provider, state, federal or CMS contracts and/or requirements indicate otherwise. Emergency and observation services are included in the inpatient reimbursement and, therefore, are not separately reimbursable expenses when performed within 24 hours prior to and including the day of the member’s admission.

Effective May 1, 2021, the following changes will occur:

1. For admitting hospitals, preadmission services are included in the inpatient reimbursement for the three days prior to and including the day of the member’s admission. Therefore, they are not separately reimbursable expenses.
2. Anthem will not consider the following services to be included in the payment window prior to an inpatient stay for preadmission services:

• Ambulance services
• Maintenance renal dialysis services
• Services provided by:
  • Skilled nursing facilities
  • Home health agencies
  • Hospices
• Unrelated nondiagnostic services

 

For additional information, please review the Preadmission Services for Inpatient Stays reimbursement policy at https://mediproviders.anthem.com/ca.