Medicare AdvantageReimbursementHigh impact
Provider Notification: New Payment Policy: ED leveling for Facility Services (CC.PP.80)
Ambetter·IN · Emergency Medicine·Claims & Billing
Effective date
Oct 27, 2026
We identified it
Aug 28, 2026
Summary
Ambetter from MHS Indiana is implementing a new payment policy for ED (Emergency Department) leveling for facility services, effective October 27, 2026. Providers must review and validate their billing and coding workflows to align with this updated guidance to ensure compliance and consistent reimbursement for ED facility claims.
Action Required
By October 27, 2026: Billing team must review the full payment policy (Clinical Payment Policies | Ambetter from MHS Indiana) and validate that all ED facility service billing and coding workflows align with the new ED leveling requirements. Share this policy update with internal billing teams and any external billing vendors. Update billing system logic and encounter documentation templates as needed to capture ED leveling information correctly. Ensure providers understand the new requirements to prevent claim denials or delays. Contact MHS at (877) 647-4848 (Monday–Friday, 8:00 a.m.–8:00 p.m. EST) if clarification is needed on policy implementation. Claims processed on or after the effective date will be subject to the new ED leveling payment policy.