Notification about submitting itemized bills

One of the greatest responsibilities Anthem Blue Cross and Blue Shield (Anthem) has to our members is to administer their benefits accurately. We conduct prepay itemized bill reviews for inpatient and outpatient services to ensure member cost shares are correctly applied. We have recently made the determination that our members would be best served if we were to require itemized bills for inpatient services billed in excess of $50,000 and outpatient services billed in excess of $20,000. This is consistent with language in your provider manual, as well as your agreement.

As you are aware pursuant to the notice you received on June 30, 2023, we implemented the following change when submitting itemized bills for Anthem inpatient and outpatient member claims on October 1, 2023, for fully insured members only:

• For inpatient services, submit an itemized bill for member claims in excess of $50,000.
• For outpatient services, submit an itemized bill for member claims in excess of $20,000.
• The itemized bill should be equal to the amount billed in order for us to process the claim.

Effective March 1, 2024, this change will also apply to ASO (administrative services only) and ITS (Inter-Plan Telecommunications Services) host claims.

We want to reduce the impact to your billing area as much as possible, so we have introduced a process that will:

• Reduce the time needed to identify a fully insured member.
• Eliminate the need to submit itemized bills when not needed.
• Integrate with your existing workflows to enable electronic submission.

Our Digital Request for Additional Information (Digital RFAI) process enables you to submit itemized bills digitally through Availity.com.

The most efficient way to submit itemized bills is through the Digital RFAI process. This is how it works:

1. Register for the Medical Attachments application on Availity.com.

2. Submit your claim through either the electronic data interchange (EDI) or the Availity.com Claims & Payments application.
3. If an itemized bill is needed, we send a notification to your Attachments Dashboard on Availity.com each morning by 8 a.m. ET.
4. You retrieve the notification and upload the itemized bill directly to your claim as an attachment.

If an itemized bill is not required for the claim, you will not receive a notification, and the claim will continue through processing.

Access the Digital RFAI webpage for learning resources, pre-recorded demonstrations, and more:

1. Start by viewing the Digital Request for Additional Information Training session.
2. For help with Availity Medical Attachment setup, access this video for additional instructions.
3. Not registered with Availity Essentials? Here’s a link to get started with Availity.

For more information, contact Availity Essentials Client Services at 800-282-4548 or use this link to take an on-demand Digital RFAI learning session.