News
72 Hour Rule Criteria Change
Date: 09/13/23
Thank you for your continued partnership with Ambetter of Tennessee As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of changes to existing review criteria that will go into place on or after *11/28/2023*.
Description of Changes | Lines of Business |
|---|---|
For the 72 Hour Rule criteria, diagnosis codes for the member’s outpatient and inpatient claims will no longer be matched and provider matching will be based on tax ID. These changes are in accordance with CMS guidelines and will apply to outpatient facility claims. | Medicare, Medicaid, Marketplace, Commercial |
Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.