System upgrade billing requirements special notice
As communicated in our June edition of Provider News, in July 2021, Anthem will replace its legacy internal provider data management system for Maine and New Hampshire contracted providers. This investment in advanced technology will significantly improve provider data accuracy and transparency, enhancing the overall provider experience.
Anthem will implement system upgrades between July 10th and July 14th. Provider updates submitted during this time will be processed after July 14th. We appreciate your patience during this time as we upgrade our systems.
Critical billing requirements
As part of our system upgrade, all data fields on a claim are used to build your claim record and submitting claims with complete and correct data is critical to ensure Anthem is able to process your claims efficiently and accurately.
Effective July 16, 2021, claims submitted with missing or incorrect billing national provider identifier (NPI) will be denied.
If you are part of a contracted provider group (organization) whose contract with Anthem is with the group (organization) and its taxpayer tax identification number, you should bill your group (organization) information, not your individual provider information when billing information is required by the claim form, including your group (organization) taxpayer ID and group (organization) billing provider NPI. For claims that require a rendering provider, please ensure you are billing the rendering provider NPI in the rendering provider field. Review your billing practices carefully to ensure proper tax identification number (TIN), billing national provider identifier (NPI) and rendering provider information (if applicable) are submitted in the appropriate fields. If claims are submitted incorrectly they will be denied.
System upgrade billing requirements special notice for Maine providers