Policy UpdatesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 31, 2024

Facility emergency department leveling reviews for providers under investigation

Effective September 1, 2024, Anthem will implement facility emergency department leveling.

Facilities must use appropriate codes and leveling for all services furnished during the emergency department (ED) encounter. The highest intervention/resource used determines the final facility ED level, which the Special Investigations (SIU) Prepayment Review team assesses for care providers under investigation who are also participating in the prepayment review program.

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Availity Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials, go to Availity.com, select state and the appropriate payer space tile from the drop-down. Then, select Chat with Payer and complete the pre-chat form to start your chat.

For additional support, visit the Contact Us section on our care provider website for the appropriate contact.

Please note: This policy does not apply for providers using the enhanced ambulatory patient grouping (EAPG) pricing methodology.

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Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-060124-24-CPN59855

PUBLICATIONS: August 2024 Provider Newsletter