Anthem Blue Cross Reimbursement Policy Guide

This document is a reimbursement policy guide from Anthem Blue Cross regarding claims that require additional documentation. It outlines the necessary documentation that must be submitted by professional and facility providers for specific types of claims to ensure proper adjudication. The policy specifies that claims involving unlisted or miscellaneous codes, clinical review requirements, potential conflicts with covered benefits, and various other circumstances necessitate additional documentation. Furthermore, it details the implications of failing to provide the requisite documentation, including potential claim denial or recoupment of previously paid claims. The health plan emphasizes the importance of adhering to proper billing and submission guidelines, including the use of standard compliant codes. The policy also notes that additional documentation may be requested by the health plan, and it outlines the history of policy revisions and related coding standards. Compliance with this policy is crucial for accurate claim submissions and reimbursements.