MedicaidAdministrativeHigh impact
[New York] Professional claims update: ensuring accurate inpatient POS reporting
Anthem BCBS·NY·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Aug 2, 2026
Summary
Effective September 1, 2026, Anthem New York Medicaid will enforce stricter claims editing to require that all services billed for inpatient individuals must use Place of Service (POS) 21 (Inpatient Hospital) or higher, regardless of where the encounter occurred. Claims submitted with inconsistent POS codes will be rejected and require correction and resubmission before reimbursement.
Action Required
By September 1, 2026: Billing team must audit and update all claim submission workflows to ensure services provided to inpatient-registered individuals are billed with POS 21 (Inpatient Hospital) or appropriate inpatient POS code, regardless of service location. Update billing system edits and encounter forms to flag inpatient status. Providers must verify patient inpatient registration status before claim submission. Train all billing staff on new POS requirements. Claims submitted with POS codes inconsistent with inpatient status will be denied and require resubmission, causing payment delays and rework.