Reimbursement policy update: Claims Requiring Additional Documentation (Facility) (MAC)

Material Adverse Change (MAC)

 

As a reminder, Anthem Blue Cross and Blue Shield (Anthem) announced the delay of a change to our facility reimbursement policy Claims Requiring Additional Documentation in the October 2020 edition of Provider News. The change would have required facilities to submit an itemized bill with outpatient facility claims reimbursed at a percent of charge with billed charges above $20,000.  We are raising the billed charges threshold to $50,000 for outpatient and will now implement with dates of service on or after August 1, 2021.

 

In addition, we are raising the itemized bill requirement for inpatient stay claims threshold from $25,000 to $100,000 and will now implement with dates of service on or after August 1, 2021.

 

1149-0521-NY-NY