Elevance Health is taking aim at a costly billing loophole: providers charging in-hospital rates for services actually delivered at off-campus facilities. Under the insurer's new policies rolling out across 2026 and 2027, providers will be required to disclose the physical location where care was provided, and that information will be cross-checked against hospital addresses to ensure appropriate reimbursement. The policies apply across Elevance's commercial, Medicare Advantage, and Medicaid lines of business.

The initiative aligns with broader momentum from Congress and federal regulators. A bipartisan spending deal passed in March will require providers to use unique National Provider Identifier numbers for off-campus billing starting in 2028, and CMS has also proposed site-neutral payment reforms in its 2027 outpatient care rule.

By the Numbers:

• $2.7 billion: Extra Medicare spending over three years for just four services billed at hospital outpatient rates instead of physician office rates (BCBS Association, 2023)
• $411 million: Higher patient out-of-pocket costs linked to the same billing disparity

Why it matters: This billing gap drives up costs for payers and patients alike — without improving care quality or changing where care is actually delivered. Elevance's proactive policy shift, backed by Congressional and regulatory action, signals a broader industry push toward site-neutral payment reform.