Policy UpdatesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingJuly 14, 2025

Ensure smooth claim processing by including NPIs on skilled services facility claims

Care providers must include their NPI when submitting facility claims for skilled services as required by HIPAA 5010 rules.

Claims filed without NPIs will encounter processing issues. This can also occur with third‑party clearinghouses. Efficient claim processing reduces administrative burdens, giving care providers more time to prioritize member care.

Can’t find your claim on Availity Essentials?

  • Correct NPI: Double‑check that you use the correct NPI to locate the claim. You can make updates to your identifiers in the Availity Essentials care provider profile.
  • Accurate patient info: Use the eligibility and benefits tool in Availity Essentials to double‑check that the patient’s name, date of birth, and ID are correct.
  • Claim issues: The claim might not have been processed. You can view claim details under Claims & Payments > Send and Receive EDI Files, or contact your billing service or clearinghouse. It can take up to 10 days for a claim’s status to show up after submission.

Additional information

Third‑party clearinghouses may encounter claims processing issues before sending them to us; therefore, care providers should check reports to find out where the issue occurred. You can find reports in Availity Essentials or via your clearinghouse. The Anthem EDI page has additional information, including EDI resources for https://Availity.com.

Helpful resources:

  • Contact Availity at 800‑AVAILITY (800‑282‑4548)
  • Availity Essentials resources and trainings are available at Payer Spaces > Anthem Tile > Custom Learning Center
  • Contact LTSS Provider Relations at 833‑569‑4739
  • Availity EDI Guide

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-084697-25

PUBLICATIONS: August 2025 Provider Newsletter