Clarification: Anthem’s enhanced claim edits for outpatient facility claims

In the June 2021 edition of Provider News, we announced additional enhancements to our claims editing systems to include an automated front end adjudication of claims edits. 

 

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  

 

1347-1021-PN-NE