Postponed - Review of professional claims with emergency room level 5 E/M codes

Category: Medicaid

 

Anthem Blue Cross and Blue Shield communicated to you on June 1, 2019, that we were initiating post-payment reviews for professional emergency room (ER) claims billed with level 5 ER evaluation and management (E/M) codes 99285 and G0384.

 

A link to this communication can be found here: http://anthem.ly/33R202v

 

The implementation of this policy has been postponed.

 

This update relates only to the policy announced June 1, 2019. All other current policies applicable to you, including but not limited to other audit or reimbursement policies pertaining to ER claims, are unaffected by this update. We will keep you informed about the initiation of the review process; however, we require proper coding and billing to ensure prompt and accurate payment.