Update to Chargemaster Audit Process

Anthem conducts retrospective Chargemaster Audits as part of its ongoing efforts to ensure contract integrity in Chargemaster pricing change impacts. Effective September 1, 2025, Anthem is revising the Commercial Provider Manual to add new language regarding the Chargemaster Audit Process to the Audit and Review section of the Commercial Provider Manual. Providing this transparency is intended to eliminate unnecessary guesswork, confusion and rework related to this analysis as well as outline the process on how these Chargemaster Audits will be conducted.

Below is a high‑level summary of the new language to be reflected in the next Provider Manual update.

Chargemaster Audit Process Overview:

• Notice of Chargemaster Audits and Requested Data
• Anthem will provide notice of a chargemaster audit along with an applicable data request, including Chargemaster and claim utilization data.
• Facilities must submit the requested data within thirty (30) days of Anthem’s chargemaster audit notice or Anthem will use its available data to complete the analysis.
• Audit Calculations and Results
• Anthem analyzes the financial impact of Chargemaster changes using a weighted average calculation based on actual Anthem commercial utilization for services reimbursed at a Percentage Rate.
• Process for Disputing Chargemaster Audit Results
• Facilities have thirty (30) days to dispute audit results with supporting documentation.
• Chargemaster Resolutions
• To remedy a Chargemaster overage, Anthem will send notice of the rate adjustment, and Facilities have thirty (30) days to reimburse Anthem for any applicable Chargemaster overage amounts. Thank you for your cooperation with the Chargemaster Audit Process.