Update: outpatient prepay itemized bill review program*

*Change to Prior Authorization Requirements

As a reminder, Anthem Blue Cross and Blue Shield’s current Outpatient Prepay Itemized Bill Review Program reviews outpatient claims more than $100,000 billed at a percent of charge prior to reimbursement to ensure items and services included on the claim are reimbursable. We are expanding the prepay program launched in 2021 requiring an itemized bill review for all outpatient services as follows:

• Effective with dates of service on or after July 1, 2022, we will add host claims and ambulatory surgery centers (ASCs) in scope.
  
  
• Effective with dates of service on or after November 1, 2022, the threshold for requiring an itemized bill for outpatient claims will decrease from $100,000 to $50,000.

INBCBS-CM-003285-22