Reimbursement policy clarification: Claims requiring additional documentation - Facility

In the May 2021 issue of Provider News, we communicated the thresholds for the itemized bill requirement for claims reimbursed at a percent of charge:

• The threshold for requiring an itemized bill for inpatient claims is $100,000.
• The threshold for requiring an itemized bill for outpatient claims is $50,000. 

 

We subsequently communicated in the August 2021 issue of Provider News that the wording of the policy was updated to remove the threshold language from the policy; however, the removal of the language from the policy DOES NOT change the thresholds in place. The communicated thresholds remain at $100,000 for inpatient and $50,000 for outpatient.

 

We will communicate any future changes in thresholds via Provider News.

 

1353-1021-PN-CNT