Reimbursement Policies

We want to help physicians, facilities and other health care professionals submit claims accurately. This page outlines the basis for reimbursement if the service is covered by an Anthem member’s benefit plan. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. Industry practices are constantly changing, and Anthem reserves the right to review and revise these policies periodically.

Definitions and Disclaimers

These reimbursement policies serve as a guide to assist you in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s benefit plan. The determination that a service, procedure, or item is covered under a member’s benefit plan is not a determination that you will be reimbursed. Services must also meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis, as well as to the member’s state of residence.

Reimbursement Policy Disclaimers 

General Reimbursement Policy Definitions