New billing requirements for provider data management system launching in April
As previously communicated in the March edition of Anthem’s Provider News, Anthem is replacing the current data management system for Georgia providers. Make sure you are familiar with new billing requirements and are prepared for the change by registering with Availity.
Critical billing requirements
Claims submitted with missing or incorrect billing national provider identifier (NPI) will be denied. Submitting claims with complete and correct data is critical to ensure Anthem is able to process your claims efficiently and accurately. All data fields on claims are used when building your claim record. Review your billing practices carefully to ensure provider tax identification number (TIN), billing national provider identifier (NPI) and servicing provider information (if applicable) are submitted in the appropriate fields.
Are you prepared?
If you are not already enrolled in Availity, it’s important that you enroll right away. Go to Availity.com to register and to find other helpful information about using Availity.
System upgrades special notice reminder
As was communicated in March, system upgrades will be implemented from April 10 through April 16, 2021. Any provider demographic updates submitted during this time will be processed after April 16, 2021. Providers should not see Anthem members prior to receiving notification that your update is finalized. As a reminder, if services are rendered to an Anthem member and claims are filed prior to the receipt of the completion date notification, Anthem is not obligated to adjust the affected claims nor are providers permitted to balance bill the member.
Next steps: integration with Availity PDM
The second phase of our system improvement will roll out in phases beginning in June. This will include integration with Availity Provider Data Management (PDM) functionality. Through this tool, providers can view, maintain, update, and attest provider demographic information is accurate for Anthem (and other health plans) in one easy-to-use portal. The PDM also features our simplified quick verification process, which enables providers to complete the required verifications online – eliminating the need to fax or email.
April 2021 Anthem Provider News - Georgia