In the June Network Update, Anthem Blue Cross published an article advising that, effective May 1, 2015, physicians and facilities would be required to obtain a pre-certification from the payor for Medicare Advantage patients with planned admissions, and to “notify” Anthem within one business day of unplanned inpatient admissions for Medicare Advantage enrollees. The article further stated that failure to do so would result in an administrative denial of the claim. 

The California Medical Association (CMA) inquired about the policy with Anthem, expressing concern that the requirement would impose a costly administrative burden for emergency and on-call physicians, would detract from patient care, and would unfairly place physicians at risk for non-payment.

In response to CMA’s inquiry, Anthem clarified that the new requirement will only apply to facilities, and will not apply to physicians. The payor further advised that they regret the error and any confusion it caused and will publish an update correcting the error in the August Network Update.