tci ED Coding & Reimbursement Alert - 2018 Issue 8

Reader Question: Could Texas Begin Denying "Non-Emergent" ED Visits?

Question: I read your article last month about Missouri’s efforts to curb Anthem’s policy of denying non-emergent visits to the ED. We have heard that this is going to expand to other payers beyond Anthem and that our Blue Cross payer here in Texas is implementing the same program. Is this true? Texas Subscriber Answer: Blue Cross Blue Shield of Texas was planning to implement a shift in its policy at the beginning of June. Under the updated policy, the payer would have denied out-of-network emergency room visits if its reviewers later determined that the visit was...

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