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Getting the Right Care at the Right Place
Act
by Jul 15, 2025
Effective date
Aug 1, 2025
Identified
Jun 26, 2026
Summary
Effective August 1, 2025, Braven Health is expanding its Site of Service policy for select outpatient elective surgical procedures to include additional non-urgent elective procedures. The insurer will now review non-emergent elective services performed in Hospital Outpatient Department (HOPD) settings and may require procedures to be performed in lower-cost settings (e.g., ambulatory surgery centers) if members lack specific medical indications, conditions, or comorbidities outlined in the medical policy.
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What to do
by Jul 15, 2025 · 5 steps
01Billing and clinical teams must obtain and review the complete Site of Service for Select Outpatient Elective Surgical Procedures medical policy from Braven Health to identify which procedures are affected and what clinical criteria determine appropriate sites of service.
02Update billing software and prior authorization workflows to flag elective surgical procedures for site-of-service review before submission.
03Notify providers and surgical scheduling staff of the expanded policy.
04Train billing staff to expect potential claim denials or rerouting if procedures are scheduled at HOPD without documented medical necessity per policy criteria.
05Implement processes to verify patient eligibility and comorbidities before surgery scheduling to avoid claim denials.
Original notice
Getting the Right Care at the Right Place
horizonblue.com · Always check the source before changing claims.