Changes to our data management system will help streamline your demographic update process

Anthem continues to work to enhance our care provider data management system, which should significantly improve your data accuracy, transparency, and experience. In the April 2023 edition of Provider News, we notified our care provider partners about our plans to begin implementing changes to our data management system. Since that time, we’ve continued to include updates and reminders in Provider News. We will begin phasing in these changes this month — September 2023.

What is important? 

• As a reminder, you are contractually required to report any practice changes.
• Tell us when care providers join your group. Notifying us in a timely manner prior to the new care provider rendering care to our members is important. 
• Ensure all your contracted care providers’ information is uploaded into our care provider data management system prior to rendering services.  
• Claims received for services rendered by a care provider who has not yet been added to your contract will be rejected or processed as out of network. 

What you need to know about billing 

As part of this data management system upgrade, Anthem is applying the Centers for Medicare & Medicaid Services (CMS) billing guidelines to hold care providers accountable for billing claims data correctly.  

Beginning in early 2024, claims submitted using rendering care providers who have not been added to your 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.  

Other important and helpful reminders

Submitting claims with complete and correct information is critical to ensuring Anthem can process your claims efficiently and accurately: 

• Bill according to standard billing guidelines.  
• Review your billing practices carefully to ensure the proper tax identification number (TIN), NPI, and rendering care provider information (if applicable) are submitted correctly. 
• Bill with a in State service location.

More information is available online at Provider Policies, Guidelines and Manuals | Anthem.com.

CMS regulations and guidance can be found here.