AdministrativeMedicare AdvantageJuly 1, 2025

Implementation of chargemaster‑based claims edit for ER leveling

Effective August 1, 2025, claims submitted by care providers who are reimbursed on a percentage‑of‑charge basis will undergo payment adjustments based on a customized chargemaster table. We use ER leveling to review emergency room evaluation and management (E/M) service claims for consistency with submitted claim elements. This table, specifically developed for percentage‑of‑charge care providers, will use historical claim data to determine the appropriate billed charge amount.

For questions or further clarification, please contact Provider Services via the number on the back of our member ID card.

Thank you for your cooperation and continued partnership.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CPN84170, MULTI-BCBS-CR-085403-25

PUBLICATIONS: July 2025 Provider Newsletter