Implementation of the new strategic provider system

In September 2023, Anthem Blue Cross (Anthem) will enhance our provider data management system. This investment in advanced technology will significantly improve care provider partners’ data accuracy, transparency, and experience. 

Critical data requirements:

• It is a contractual requirement to submit new providers joining your group in a timely manner prior to the new provider rendering care to members.
• Ensure all your contracted providers are submitted to Anthem and loaded to our provider data management system prior to rendering services. 
• Claims received for services rendered by a provider who has not yet been added to the contract will be rejected or processed as out of network.

Critical billing requirements

As part of this system upgrade, Anthem is enforcing the Centers for Medicare & Medicaid Services (CMS) billing guidelines that hold providers accountable for billing claims data correctly. 

Beginning in early 2024, claims submitted with rendering providers who are not loaded to the contract by the date of service billed, or with missing or incorrect national provider identifiers (NPIs), will be rejected for more information or processed as out of network. Submitting claims with complete and correct data is critical to ensure Anthem can process your claims efficiently and accurately: 

• Bill according to standard billing guidelines. 
• Review your billing practices carefully to ensure proper tax identification number (TIN), national provider identifier (NPI), and rendering provider information (if applicable) are submitted in the appropriate fields. 

More information is available online. Visit https://bit.ly/3WgarBa for Anthem reimbursement policies and access CMS regulations and guidance at the government website at https://go.cms.gov/434M4cB.