Anthem / BCBS Provider Guide
Complete guide for Anthem Blue Cross Blue Shield credentialing, billing, and claims management
State-Specific Note: Anthem operates BCBS plans in 14 states. Requirements may vary by state. Always verify state-specific policies.
Avg. Credentialing
90-150 Days
Timely Filing
180 Days
Appeal Window
180 Days
Portal
Availity
Credentialing & Enrollment
Anthem Credentialing Process
Key Requirements
- • Current medical license in state(s) of practice
- • Board certification (strongly preferred)
- • Malpractice insurance: $1M/$3M minimum
- • DEA registration (if prescribing)
- • CAQH profile updated within 120 days
- • Clean NPDB and state licensing records
Anthem-Specific Notes
Anthem credentialing timelines vary by state. CA and NY tend to take longer (120-150 days). Some states require site visits for behavioral health providers.
Anthem participates in CAQH but may still require supplemental applications for certain states or provider types.
Top Anthem Denial Codes
CO-197: Precertification/authorization requiredMost Common
Why Anthem Uses This
Anthem has extensive prior authorization requirements, especially for outpatient procedures, therapy, and imaging.
Resolution
Submit retroactive authorization with clinical documentation. Success rates vary by service type and medical necessity.
CO-29: Time limit for filing has expired
Why This Happens
Anthem's timely filing limit is 180 days from date of service. This is shorter than many other payors.
Prevention
Submit claims within 90 days to allow time for corrections. Track submission dates carefully.
CO-B7: Benefit maximum reached
Common Scenarios
Outpatient therapy limits, chiropractic visit caps, and behavioral health visit maximums are common with Anthem plans.
What to Do
Verify benefits before starting treatment. For medically necessary care beyond limits, submit an exception request with clinical documentation.
State-Specific Considerations
California (Blue Cross CA)
• Longer credentialing times (120+ days)
• Strict facility requirements for BH providers
• Separate delegated entities for some services
New York (Empire BCBS)
• State-mandated timely payment laws
• Different appeals process from other states
• Requires NY-specific provider agreements
Virginia (Anthem BCBS VA)
• Standard 90-120 day credentialing
• Active site visit program
• Strong behavioral health network
Other Anthem States
CO, CT, GA, IN, KY, ME, MO, NV, NH, OH, WI
Check state-specific provider manuals
Contact Information
Provider Services
General Provider Line
1-800-676-2583
Prior Authorization
1-866-365-2126
Claims Inquiries
1-800-676-2583
Credentialing
Contact state-specific office
Provider Portal
Availity or Anthem.com/provider