As communicated in the April newsletter, the 2019 Ohio provider manual is available online. Since posting the manual, a correction has been made in the section “Test or Procedures Prior to Admission(s) or Outpatient Services,” page 59.  We mistakenly included the term “days” as opposed to “hours” in the following statements:


Unless the Provider or Facility Agreement with Anthem specifies a different timeframe, pre-admission/pre-surgical/ pre-operative testing that occurs within seventy-two (72) hours prior to the inpatient admission or outpatient procedure will be included in the DRG Rate, Per Diem Rate, Case Rate or any other Anthem Rate for Covered Services, and shall not be billed or paid separately. All Claims billed separately for these services must be accompanied with the appropriate ICD-10 codes. 


This error has since been corrected.

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June 2019 Anthem Provider Newsletter - Ohio