AdministrativeCommercialDecember 31, 2019

Postponed: Review of professional claims with emergency room level 5 E/M codes

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

In the May 2019 edition of Provider News, Empire BlueCross BlueShield (“Empire”) communicated to you that we were initiating post-payment reviews for professional ER claims billed with level 5 ER E/M codes 99285 and G0384. Empire’s implementation of this policy has been postponed. This update relates only to the policy announced on May 1, 2019. All other current policies applicable to you, including, but not limited to, other audit or reimbursement policies pertaining to ER claims are unaffected by this update. We will keep you informed about the initiation of the review process; however, as always, we require proper coding and billing to ensure prompt and accurate payment.

PUBLICATIONS: January 2020 Empire Provider News