Anthem: New Inpatient Facility Claim Requirements Effective January 1, 2026

Anthem Blue Cross and Blue Shield (Missouri) announced new documentation requirements for inpatient facility claims effective January 1, 2026. The changes apply when a patient’s inpatient admission date precedes their Anthem coverage effective date.

To support accurate coordination of benefits and speed up claims processing, Anthem will now require:

• Explanation of Benefits (EOB) from the patient’s previous insurance carrier, including:
  • Carrier name
  • Address
  • Phone number
  • Email address
• An indication of whether the prior carrier covered the inpatient stay from admission through discharge
• A detailed itemized bill for all associated charges

These requirements are intended to ensure proper claim adjudication when members transition between insurers during an inpatient stay.

Provider impact:

Hospitals and inpatient facilities will need to collect and submit more comprehensive documentation up front. Missing or incomplete prior carrier information may result in claim delays, pended claims, or denials, making accurate eligibility verification and documentation workflows critical.

Source: https://providernews.anthem.com/missouri/articles/new-inpatient-facility-claim-requirements-effective-january-27766