Anthem Revises ‘Avoidable’ 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 “avoidable” emergency department visits. “Specifically, we have expanded our list of ‘always-approve’ exceptions,” the notice states. “We 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.” 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.