Reimbursement policy clarification: Claims Requiring Additional Documentation (facility)
- The threshold for requiring an itemized bill for inpatient claims is $100,000.
- The threshold for requiring an itemized bill for outpatient claims is $50,000.
We subsequently communicated in the August 2021 Provider News that the wording of the policy was updated to remove the threshold language from the policy; however, the removal of the language from the policy DOES NOT change the thresholds in place. The communicated thresholds remain at $100,000 for inpatient and $50,000 for outpatient. We will communicate any future changes in thresholds via Provider News.
October 2021 Anthem Provider News - Nevada