Anthem Revises 鈥楢voidable鈥� ED Visit Policy in MO, KY and GA
Anthem last week notified network providers in Missouri, Kentucky and Georgia about changes to its program to prevent 鈥渁voidable鈥� emergency department visits. 鈥淪pecifically, we have expanded our list of 鈥榓lways-approve鈥� exceptions,鈥� the notice states. 鈥淲e will take that new list of exceptions and look back at claims that were previously denied. If one of those conditions was present, we will change the decision and pay the claim according to the terms of the benefit plan.鈥� While the program also was implemented in Ohio and Indiana Jan. 1, reviews in these states have already occurred, the notice states. Anthem has not released the complete list of exceptions; however, news reports indicate that they include instances where an individual is directed to an ED by clinical personnel.