[

As previously communicated through Partners in Health Update℠ and published in the Provider Manual for Participating Professional Providers, AmeriHealth requires that professional claims be billed on one CMS-1500 claim form or electronic 837P transaction when two or more services are performed for the same patient, by the same performing provider, and on the same date of service. The only exception would be when we specifically require services to be billed on separate claims based on an AmeriHealth policy (i.e., assistant or co-surgery claims).

Claims submitted otherwise are considered split-billed claims when there is no policy that requires billing on separate claims. More specifically, claims are considered split-billed when more than one claim is submitted for payment for two or more services performed for the same patient, by the same performing provider, and on the same date of service and there is no policy to support split-billing.

Some examples of split-billing include:

• two or more procedures or services performed by the same performing provider, on the same date of service, on the same patient, submitted on more than one claim form;
• services considered included in the primary services and procedures as part of the expected services for the codes billed on separate claim forms.

Providers must bill for all services performed on the same day for the same patient on a single claim form. Failure to do so prohibits the application of all necessary edits and/or adjudication logic when processing the claim. As a result, claims may be under- or over-paid and member liability may be under- or over-stated.

As a reminder, if more than one CMS-1500 claim form or electronic 837P transaction is received for services performed on the same patient, by the same performing provider, and on the same date of service as a previously submitted claim, and there is no policy to support split-billing, we will adjust all individually submitted claims to deny. Providers will be required to submit the split-billed services as a single, new claim for payment consideration.

To the extent that service(s) for which there is no policy to support split-billing is inadvertently omitted from a previously submitted claim, the previous claim should be corrected. To submit a corrected claim, please use the Claims Investigation transaction on the NaviNet^® web portal. Please do not submit a separate claim for the omitted services, as that will create a split-billed claim and all individually submitted claims will be adjusted to deny.

NaviNet is a registered trademark of NaviNet, Inc.

]