Reimbursement policy update - Claims Requiring Additional Documentation (facility)

We continue to take steps to improve the payment accuracy of provider claims and reduce post-payment recoveries. To this end, beginning with dates of service on or after August 1, 2020, we will update our Claims Requiring Additional Documentation policy to include the following requirement: 

 

• Inpatient stay claims reimbursed at a percent of charge with billed charges above $25,000 will require an itemized bill to be submitted with the claim.
• Outpatient facility claims reimbursed at a percent of charge with billed charges above $20,000 require an itemized bill to be submitted with the claim.

 

For more information about this policy, visit the Reimbursement Policies page at anthem.com.

 

433-0520-PN-NH

434-0520-PN-NH