Medical Recalls (reimbursement for recalled items and related procedures)
Governs reimbursement for repair, replacement, removal, and replacement procedures related to medically recalled items for Anthem HealthKeepers Plus Medicaid members and providers billing HealthKeepers, Inc.; affects participating and non‑participating professional providers and facilities.
Added implantable devices under applicable items.
Added the phrase 'or item' to policy language.
Coverage criteria for recalled items and related procedures
Coverage criteria for recalled items and related procedures
Covered when ALL of the following apply:
Coverage prerequisites
- Repair or replacement of items due to a medical recall is not reimbursed unless provider, state, federal, or CMS contracts indicate otherwise.
- Applicable items include: durable medical equipment; supplies; prosthetics; orthotics; drugs/vaccines; implantable devices.
Reimbursable procedures
- Medically necessary procedures to remove recalled or replaced devices or items will be reimbursed.
Payment adjustments and recoupment
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.