Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 1, 2024
Reimbursement policy update: Nurse Practitioner and Physician Assistant Services
(Policy G-20002, effective 2/01/2025)
Beginning with dates of service on or after 2/01/2025, Anthem will update the Nurse Practitioner and Physician Assistant Services reimbursement policy as indicated below.
The following services were removed from the policy and are eligible for a payment reduction when billed by NP/PA provider.
- Preventive Services
- Radiology Services
The following physician’s services are not subject to the NP/PA reimbursement payment reduction and the services are included in the not considered for payment reduction section.
- Drugs
- Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS)
- Laboratory Services and Laboratory Screening Services
Under the current reimbursement structure, no payment reduction will be applied to the NP/PA services as mentioned above when the provider is employed by a physician group.
For additional information, please review the Nurse Practitioner and Physician Assistant Services reimbursement policy at providers.anthem.com/in.
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-067374-24-CPN66373
PUBLICATIONS: November 2024 Provider Newsletter
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