Reimbursement policy update: claims requiring additional documentation (Facility)

As we advised you in the October 2018 edition of Network Update, in our efforts to improve payment accuracy and reduce post-payment recoveries, beginning with dates of service on or after January 1, 2019, 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 our Reimbursement Policy page on our anthem.com/provider website. On the website you can also view the instructions on how to submit your itemized bill to Anthem.