Notice of readmission processing change

We are updating our process for reviewing readmissions. As you may know, our current process is performed post-payment via coding and claims analysis.

Our revised process will move this review to our Utilization Management team, pre-payment, and will occur at the time of the admission. This will allow for an immediate review and notification to facility of an admission that meets our contractual requirements for a readmission. This updated process also provides the opportunity for a peer-to-peer in the event it is determined to be a readmission.

This is an update to our processing to allow for more efficient processes. This is not a medical necessity review and does not change or replace that process. It is not a change to our policies or your contract.

Our updated review process for readmissions will begin on May 1, 2024, unless you have been notified otherwise by Anthem.

We continue to work towards identifying simplified ways to access care.