Outpatient Prepay Itemized Bill Review Program update - Facility

As a reminder, we have expanded the current Outpatient Prepay Itemized Bill Review Program to include host business and ambulatory surgery center (ASC) facility claims. The program currently reviews outpatient claims more than $100K billed at a percent of charge prior to reimbursement to ensure items and services included on the claim are reimbursable. Beginning February 1, 2023, this initiative will lower the threshold for itemized bill reviews to $50K.

 

MOBCBS-CM-009213-22