We’re enhancing our data management system to streamline your demographic update process

Anthem is working to enhance our provider data management system, which should significantly improve your data accuracy, transparency, and experience. 

Important contract requirements:

• It is contractually required for you to make us aware of new providers joining your group. You must notify us in a timely manner prior to the new provider rendering care to our members.
• Ensure all of 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.

Important billing requirements

As part of this data management system upgrade, Anthem is applying the Centers for Medicare & Medicaid Services (CMS) billing guidelines to hold 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 national provider identifiers (NPIs), will be rejected for more information or processed as out of network. 

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 tax identification number (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.