Reimbursement policy reminder: Readmission - facility

As a reminder, Anthem does not allow separate reimbursement for claims that have been identified as a readmission for the same, similar, or closely-related diagnoses or condition to the same facility or another facility that:

 

1. operates under the same facility agreement,
2. has the same tax identification number as facility, or
3. is under common ownership as facility, as further described in the existing reimbursement policy.

 

For more information about this policy, visit the Reimbursement Policies page at anthem.com.  

 

If we determine that this reimbursement policy has not been followed, we may deny the claim prior to payment or recover any paid claim. Providers may dispute any claim denied under this policy consistent with applicable law, your agreement with Anthem, and Anthem policies.

 

1123-0521-PN-NE