Elevance Health plans to require hospitals to identify the physical location where care was provided on billing forms and adjust payments for off-campus services accordingly.
The insurer said Sept. 29 the new policies will apply across its commercial, Medicare Advantage and Medicaid plans and are designed to address situations where care delivered at off-campus locations is billed at higher hospital outpatient rates. Elevance said it is the first commercial payer to go public with requiring physical location data on claims and tie reimbursement to that information. The company plans to roll the policies out through the end of 2027.
Catherine Gaffigan, MD, president of health solutions at Elevance, announced the change during a Tuesday morning panel at the MAHA Summit in Washington, D.C., where she appeared alongside leadership from UnitedHealth, AHIP and CMS.
“Patients and employers should be able to trust that healthcare bills accurately reflect where care was provided,” Dr. Gaffigan said in a news release.
Elevance said it will check billing data against hospital addresses to verify where care took place, pay certain off-campus hospital services at off-campus rates and block hospital-rate billing for lab tests performed at other locations. The insurer began notifying providers earlier this year that certain off-campus services would be reimbursed at the applicable off-campus rate.
The move comes amid a regulatory environment that has been tightening around hospital outpatient billing. A federal law enacted in February requires hospitals to meet new identification and reporting requirements for off-campus outpatient departments by 2028, or risk losing Medicare reimbursement.
CMS has also been expanding site-neutral payment policies incrementally, with the agency’s 2026 outpatient rule applying site-neutral rates to drug administration services at off-campus hospital departments, along with a proposal to extend that approach to imaging services like X-rays and MRIs.
In its announcement, Elevance cited Blue Cross Blue Shield Association figures showing Medicare paid an additional $2.7 billion and patients paid $411 million more out-of-pocket over three years when certain services were delivered in hospital outpatient settings rather than physician offices. A BCBSA analysis earlier this month estimated that site-neutral imaging payments alone would save $9.7 billion across Medicare and commercial markets over 10 years.
