Implementation of the new strategic provider system

In April, we announced that a new strategic provider system would replace our legacy internal provider data management system in August 2023. Please be advised that the launch of the new system has been delayed and will not be implemented in August as originally announced. We will advise you of the new launch date in a future edition of Provider News.

Anthem is working to 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 that 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.

Colorado —https://anthem.com/provider/policies

CMS regulations and guidance —https://cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26pdf.pdf