Claims requiring additional documentation facility reimbursement policy update

As we advised you in the April 2018 Network Update and September 2018 Network eUpdate, in our efforts to improve payment accuracy and reduce post-payment recoveries, beginning with dates of service on or after July 13, 2018, we updated our Claims Requiring Additional Documentation policy to include the following requirement: 

 

• Inpatient stay claims reimbursed at a percent of charge with billed charges above $40,000 require an itemized bill to be submitted with the claim.

 

We continue to receive claims without the required itemized bill causing the claims to be returned for the itemization. To help ensure accuracy and eliminate delays in the adjudication of your claims, the itemized bill must be included with qualifying claim submissions. 

 

For more information about this policy, visit the Administrative, Billing and Reimbursement Policies page at anthem.com/provider.

 

In addition, visit our anthem.com provider website to view the instructions on how to submit your itemized bill to us.