Medicare AdvantageReimbursementHigh impact
[Georgia] Reimbursement policy update: Preventive Medicine and Sick Visits on the Same Day
Anthem BCBS·GA·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Medicare Advantage plans in Georgia will reimburse sick visits and preventive services billed on the same day at 50% of the applicable fee schedule or contracted rate. Billing teams must identify same-day visits during claims processing and apply the 50% reduction to avoid claim denials or post-payment recoupments.
Action Required
By March 15, 2026: Billing team must update claim submission and adjudication protocols in billing software to identify and flag same-day preventive + sick visit combinations for Anthem Medicare Advantage Georgia claims. Modify billing rules to automatically apply 50% reimbursement reduction to the applicable service on same-day visits. Train front desk and clinical staff to alert billing team when preventive and sick visits are scheduled on the same date. Update encounter forms and EMR templates to prompt providers to document visit type (preventive vs. sick) separately. Verify with Anthem's provider portal for any prior authorization or claim submission guidance. Failure to apply the 50% reduction will result in claim denials or post-payment recoupments from Anthem.