Medicare AdvantageReimbursementHigh impact
[New York] Reimbursement policy update: Preventive Medicine and Sick Visits on the Same Day
Anthem BCBS·NY·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Medicare Advantage plans in New York will reimburse sick visits and preventive services performed on the same day at 50% of the applicable fee schedule or contracted rate, rather than at full reimbursement. Billing teams must adjust claim submission logic and provider documentation to account for this bundling reduction when preventive and sick visit services occur on the same date of service.
Action Required
By March 15, 2026: Billing team must update billing software to automatically reduce reimbursement to 50% when both preventive/wellness visit codes and sick visit codes are billed on the same date of service for Anthem Medicare Advantage New York claims. Update encounter forms and provider communication to flag when same-day preventive and sick visits are documented, requiring providers to determine if services should be split across different dates or billed as a single encounter. Implement claim auditing rules to catch underpayment corrections before submission. Train billing staff on the new policy logic. Failure to apply the 50% reduction will result in overpayment recovery and potential audit issues with Anthem.