Changes to our data management system help streamline your demographic update process

Anthem continues to work to enhance our provider data management system, which should significantly improve your data accuracy, transparency, and experience. In May 2023, we mailed letters notifying our care provider partners about our plans to begin implementing changes to our data management system. Since that time, we’ve included reminders in our provider newsletter, Provider News. We completed the implementation of these changes in September 2023.

What is important?

• As a reminder, you are contractually required to report any practice changes.
• Tell us when providers join your group. Notifying us in a timely manner prior to the new provider rendering care to our members is important.
• Ensure all your contracted providers’ information is uploaded into our provider data management system prior to rendering services.
• Claims received for services rendered by a provider who has not yet been added to your contract will be rejected or processed as out of network.

As we communicated in October, the Availity Essentials Provider Data Management (PDM) application and Symphony file-based data exchange are now the two options for care providers to submit demographic change requests, including submitting roster uploads. Availity PDM and Symphony will replace all current intake channels for demographic change requests and roster submissions as of January 1, 2024. Read the previous communication here.

If preferred, care providers may continue to use the Provider Enrollment application in Availity Essentials to submit requests to add new practitioners under existing groups.

What you need to know about billing

As part of this data management system upgrade, Anthem is applying CMS billing guidelines to hold care providers accountable for billing claims data correctly.

Beginning in early 2024, claims submitted using rendering providers who have not been added to your contract by the date of service billed or with missing or incorrect NPIs will be rejected for more information or processed as out of network.

Other important and helpful reminders

Submitting claims with complete and correct information is critical to ensuring Anthem can process your claims efficiently and accurately:

• Bill according to standard billing guidelines.
• Review your billing practices carefully to ensure the proper TIN, NPI, and rendering provider information (if applicable) are submitted correctly.

More information is available online at anthem.com/ca/provider/policies. CMS regulations and guidance can be found here.