New provider effective date process

This communication applies to the Commercial, Medicaid, and Medicare Advantage programs for Anthem Blue Cross and Blue Shield (Anthem).

 

Effective January 1, 2022, the Anthem effective date policy was updated. This process applies to Anthem networks in Indiana, including Commercial, Medicare Advantage HMO/PPO, Hoosier Healthwise, Hoosier Care Connect, Healthy Indiana Plan and Worker’s Compensation:

• A brand-new provider who is not part of an existing contract with the managed care entity (MCE) will be effective the first of the month following contract execution.
• A provider that is being added to an existing contract will be effective the first of the month following receipt of the network participation request from the provider. The network participation receipt date is the date Anthem receives the provider’s complete network participation request electronically via our online portal. All required fields must be completed, required supporting documentation provided, Council for Affordable Quality Healthcare, Inc. (CAQH) completion, etc. for the network participation request to be considered complete.
• If a provider is unable to be credentialed with Anthem, the provider will not be effective.
• If a provider does not return the signed contract, the provider will not be effective.
• Providers should hold all claims until the final welcome letter from the Anthem is received confirming that they are effective with the Anthem network.

 

1235-0322-PN-IN