Readmission review process change

Effective August 1, 2025, certain facilities will implement a new readmission review process that moves the review to the time of readmission request. This allows for an immediate review and notification to the facility of an admission that meets the contractual language of a readmission. It also provides the opportunity to communicate with Anthem’s medical director in the event of a contractual issue.

This change is an update in our processing and functions solely as a contractual review. This new process is not a change to any existing policy or contract. This new process is not a medical necessity review. The medical necessity review process remains unchanged.