In the past year, the AMA Dept. of Private Sector Advocacy has had an increase in complaints from state and specialty societies concerning Anthem payment procedures. The focus of the complaints are related to claims with modifiers that Anthem has down coded or bundled in what the groups have seen as an effort to avoid and delay payment of common claims. "Anthem's apparent arbitrary and unilateral [and potentially inconsistent] application of CPT codes, guidelines and conventions has created confusion and uncertainty and, based upon the complaints we have received, has led to misunderstandings by physicians and nonphysician health care professionals regarding Anthem's payment rates for certain services," noted the letter, signed by the AMA and state, county and specialty medical societies. For the complete article and a copy of the letter, please go to www.ama-assn.org

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