BCBS Provider Guide (Anthem Plans)
State-specific notes for Anthem-operated Blue Cross Blue Shield plans: credentialing, prior authorization, billing, and appeals
Credentialing for Anthem BCBS
Process Overview
• Maintain an updated CAQH profile (last attestation within 120 days)
• Supply malpractice coverage minimum $1M/$3M and DEA (if applicable)
• Expect 90–150 days processing; longer in CA and NY
• Some states use delegated credentialing or require site visits (BH)
State Variations
Empire (NY), Anthem BCBS VA, Blue Cross CA, and others have additional steps. Verify state manuals and delegated entities before submitting.
Common BCBS Denials (Anthem)
CO-197: Authorization Required
• Prior auth requirements are extensive for outpatient procedures, imaging, therapy
• Submit retro auth where appropriate with compelling clinical documentation
CO-29: Timely Filing Exceeded
• Anthem BCBS commonly enforces 180-day limits
• Submit within 90 days to allow corrections and resubmissions