Medical records needed for accurate payment of certain facility inpatient claims

To help ensure inpatient claims are processed quickly and accurately, and consistent with our Claims Requiring Additional Documentation reimbursement policy, starting May 1, 2025, inpatient claims with billed charges over $100,000, reimbursed partly or fully based on a percentage of charges, must include the full medical record upon submission. There is no impact to a member's ability to receive care.

The claim and medical record may be reviewed prior to claim payment or audited after claim payment. If claims meeting the above criteria are received without medical records, the claim will not be eligible for reimbursement until submitted with the appropriate documentation.

To view the full reimbursement policy, please visit our website: anthem.com/provider

Submit medical records with initial claim filing

Facilities can proactively submit medical records digitally with the initial claim filing via our preferred clearinghouse, Availity Essentials (https://Availity.com), through the Claim Status application. For additional options on claim and medical record submission, consult the provider manual at anthem.com/provider.

If your facility is not already registered for Availity Essentials or the Medical Attachments application, complete registration at https://Availity.com. Registering for the application allows facilities to receive digital notifications if documentation is required to complete a claim.

Training resources on submitting medical records attachments are available on our Digital Solutions Learning Hub. Trainings that begin with Attachments in the title provide education on this topic.