Policy Updates Reimbursement PoliciesCommercialMay 31, 2023

New reimbursement policy: Provider Preventable Conditions – Professional and Facility

Anthem Blue Cross and Blue Shield (Anthem) recognizes the importance of addressing provider preventable conditions for our members and, as a result, has adopted an enterprise-wide focus on patient safety. To facilitate this effort, we have started reaching out to providers when a hospital acquired condition or major surgical never event has been identified.

Beginning with dates of service on or after September 1, 2023, Anthem will expand the current Preventable Adverse Events – Facility reimbursement policy as follows:

  • In addition to facility providers, the policy will now be applied to professional providers
  • The policy will address Anthem - defined provider preventable conditions (PPC)

The policy will be retitled Provider Preventable Conditions – Professional and Facility, and the Preventable Adverse Events – Facility reimbursement policy will be retired.

For specific policy details, visit the reimbursement policy page.

MULTI-BCBS-CM-025130-23

PUBLICATIONS: June 2023 Provider Newsletter