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Pre-admission testing reimbursement policy changes

Effective October 1, 2021, we will change how we consider certain claims for preadmission testing services based on our updated Pre-Admission Testing reimbursement policy guidelines.

Outpatient services submitted on claims for services performed on and after October 1, 2021, by an admitting hospital or an associated or affiliated entity (i.e., part of the hospital system, an affiliated ambulatory surgery center or urgent care center, etc.) — on the day of, or within the 72-hour period prior to the day of, a patient’s planned inpatient admission or same-day surgery service — will be considered Pre-Admission Testing (PAT) services. Services will not be considered for separate reimbursement regardless of the diagnosis code(s) submitted on impacted claims. This includes COVID-19 testing for all planned inpatient admissions and
same-day surgery services.

The policy guidelines apply to patients enrolled in all fully insured commercial plans, Medicare Advantage plans, including Braven Health℠ plans, and Administrative Services Only employer group plans, including the State Health Benefits Program (SHBP)/School Employees’ Health Benefits Program (SEHBP) plans.

Horizon reserves the right to adjust claims for PAT services provided on and after October 1, 2021, that are not processed according to the policy guidelines. We encourage you to visit to review the content of our Pre-Admission Testing reimbursement policy.

Published on: June 30, 2021, 14:38 p.m. ET
Last updated on: June 30, 2021, 14:41 p.m. ET