CommercialCoverageHigh impact
12.06.01, Level of Care for Elective Procedures (Hospital Inpatient to Hospital Outpatient Level of Care)
Independence Blue Cross·Medical Policy
Effective date
Jun 1, 2026
We identified it
Jun 19, 2026
Summary
A new policy has been implemented establishing criteria for determining when elective procedures should be performed at hospital outpatient level of care instead of inpatient level of care. This policy will affect how providers justify and bill for elective procedures requiring hospitalization.
Action Required
Before June 1, 2026: Billing team and providers must review all elective procedure scheduling to ensure appropriate level of care designation (inpatient vs outpatient). Update pre-authorization processes to align with new level of care criteria. Providers must document medical necessity justifying inpatient level when required. Claims may be denied or downgraded if level of care criteria are not met.