Clarification: Anthem’s enhanced claim edits for outpatient facility claims
To clarify, this enhancement does not affect any of our reimbursement policies. The enhanced edits update our claims editing process for outpatient facility claims.
These enhanced edits provide an opportunity to shift certain existing back-end reviews to front-end adjudication for outpatient facility claims including but not limited to scenarios with:
- Revenue code billing
- CPT/HCPCS code reporting
- Modifier usage
October 2021 Anthem Provider News - Nevada