Part B Insider - 2018 Issue 7
Denials: One State Aims to Quell Anthem's ED Denials
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Article Overview
This article covers a state-level effort to address emergency department claim denials associated with a major insurer’s policy in several states. It explains the policy context, the consumer and provider concerns driving the response, and the legislative approach aimed at clarifying how emergency visits are evaluated. The piece is relevant to emergency department coding and billing professionals, compliance staff, and anyone tracking payer policy changes and state insurance legislation.
Why This Topic Matters
Emergency department denials can affect patient financial responsibility, payer review practices, and provider reimbursement. Understanding this policy and the related legislative response helps coding and billing teams monitor documentation, claims review, and evolving state requirements.
Article Sections
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Background on Anthem's ED policy
Provides the policy context and explains the multi-state scope of the issue. It also summarizes the concerns raised by patients, providers, and professional organizations.
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Missouri Lawmakers Take Action
Describes the state legislative response and its focus on how emergency department claims are evaluated. It also notes the status of the legislation at the time of publication.
What You Will Learn
- How a payer policy affecting emergency department claims is being challenged at the state level
- What types of stakeholders are concerned about emergency department denials
- How state legislation can address emergency visit review standards
- Why emergency department policy changes matter for coding and billing teams
Who Should Read This
- Emergency department coders
- Medical billing professionals
- Compliance staff
- Revenue cycle teams
- Health policy readers
- Insurers and payer policy analysts
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