Update: outpatient prepay itemized bill review program*
*Material Adverse Change (MAC)
As a reminder, Anthem Blue Cross and Blue Shield’s current Outpatient Prepay Itemized Bill Review Program reviews outpatient claims more than $100,000 billed at a percent of charge prior to reimbursement to ensure items and services included on the claim are reimbursable. We are expanding the prepay program launched in 2021 requiring an itemized bill review for all outpatient services as follows:
- Effective for dates of service on or after July 1, 2022, we will add host claims and ambulatory surgery centers (ASCs) in scope.
August 2022 Anthem Provider News - Wisconsin