Reimbursement policy reminder: readmission (facility)
May 2021 Anthem Provider News - Georgia
May 1, 2021 • Policy Updates / Reimbursement PoliciesAs a reminder, Anthem Blue Cross and Blue Shield (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 (i) operates under the same Facility Agreement, (ii) has the same tax identification number as facility, or (iii) is under common ownership as facility, as further described in the existing reimbursement policy found here: Commercial Readmission Policy. If Anthem determines that this reimbursement policy has not been followed, Anthem 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.