Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

New Anthem Credentialing Guidelines Beginning July 1, 2016

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Effective July 1, 2016, Anthem will start requiring credentialing for several additional practitioner and health delivery organization (HDO) provider types. The process involves verification of basic professional conduct and competency criteria, including licensure, education and training, and sanction activity. Each provider’s application will be reviewed by a local credentialing committee or medical director for approval; re-credentialing will occur every three years thereafter.

For providers in these categories who are newly contracted (i.e., initial applicants), the credentialing process will start July 1. For these same provider types who already have a contract in place, a credentialing process will be developed to ensure their credentialing is complete within the next 18 months.

Practitioner Providers

Practitioner provider types affected include the following who are contracted independently by Anthem, contracted at a group practice level by Anthem and are listed in the Anthem directories, or licensed by the state to practice independently:

  • Licensed genetic counselors
  • Audiologists
  • Acupuncturists (non-medical doctors (MD) or doctors of osteopathic medicine (DO))
  • Nurse practitioners, certified nurse midwives, and physician assistants
  • Registered dietitians

These practitioners will use the Council for Affordable Quality Healthcare’s (CAQH) ProView online service to submit their credentialing information.

Providers already using CAQH should keep their application updated to avoid delays in the credentialing process and provider directory listings. Anthem will add all current providers affected by this new credentialing policy to their CAQH Roster. Providers who currently use CAQH’s Global Authorization will automatically authorize Anthem’s use of their record. Other providers should manually authorize Anthem to view your credentials.

Providers not currently using CAQH can self-register with CAQH at www.caqh.org, or contact the CAQH ProView Support Desk with questions by e-mail at providerhelp@ProView.CAQH.org.

HDO Providers

The following HDO provider types who are contracted independently by Anthem or are listed in the Anthem directories will be affected by the July 1 start date for credentialing:

  • Behavioral health facilities providing mental health and/or substance abuse treatment in inpatient, residential or ambulatory settings
  • Birthing centers
  • Convenient care centers/retail health clinics/walk-in clinics
  • Federally qualified health centers (FQHC)
  • Intermediate care facilities
  • Home infusion therapy
  • Rural health clinics
  • Urgent care centers

HDO and facility providers will not use the Practitioner CAQH ProView application process referenced above. Instead, these providers will complete the Health Delivery Organization/Facility Application located at anthem.com > Providers > (enter your state) > Answers@Anthem > HDO/Facility Form.

For more information about this change in Anthem credentialing guidelines, review the recent Anthem Network update where the announcement was made or contact the CIPROMS Provider Enrollment team using our Contact Form.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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