AdministrativeMedicare AdvantageJuly 1, 2025

Implementation of chargemaster‑based claims edit for ER leveling

Effective August 1, 2025, claims submitted by care providers who are reimbursed on a percentage‑of‑charge basis will undergo payment adjustments based on a customized chargemaster table. We use ER leveling to review emergency room evaluation and management (E/M) service claims for consistency with submitted claim elements. This table, specifically developed for percentage‑of‑charge care providers, will use historical claim data to determine the appropriate billed charge amount.

For questions or further clarification, please contact Provider Services via the number on the back of our member ID card.

Thank you for your cooperation and continued partnership.

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWI), Compcare Health Services Insurance Corporation (Compcare), and Wisconsin Collaborative Insurance Company (WCIC). BCBSWI underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CPN84170, MULTI-BCBS-CR-085403-25

PUBLICATIONS: July 2025 Provider Newsletter