Anthem Credentialing Services for your Independent Practice

Anthem employs credentialing to examine and choose licensed independent practitioners to offer care to our members. For credentialing, Anthem employs the Council for Affordable Quality Healthcare (CAQH) ProView programme. This private and secure gateway decreases the amount of paperwork required to complete the credentialing procedure.

Overview

The Credentials Committee (CC) makes all credentialing decisions and reports to the Anthem governing board. Under the authority of Anthem’s governing body and the direction of Anthem’s Chief Medical Officer, the CC is authorized to evaluate all health care practitioners and Health Delivery Organizations (HDOs) applying for or seeking continued participation in the Anthem network, within the scope of the Anthem Credentialing program.

Our Specialist will help you to get Credentialed Now!

The credentialing phase will involve examining your educational background, employment history, certifications, and registration to practice in a healthcare field, which we will follow you through.
We will follow you during the credentialing process to assess your education, training history, credentials, and registration to practice in a health care area. We will go over all of your papers so that you can be certified at one of the world’s best healthcare providers. We are committed to long-term growth as a team. We will assist you in receiving the services you require. This is how we demonstrate to our clients how much we value them and strive to offer great customer service.

Who can be credentialed?

Anthem credentialing includes, but is not limited to, the following types of health care practitioners:

• Medical doctors

• Doctors of osteopathic medicine

• Chiropractors

• Telemedicine practitioners who have an independent relationship with Anthem and provide treatment services under the health benefits plan

• Medical therapists (such as physical therapists, speech therapists, and occupational therapists)

• Nurse practitioners who are licensed, certified or registered by the state

Credentials Committee

The Credentials Committee (CC) is a peer review group with decision-making authority for a practitioner’s involvement in a network or Plan. The CC will convene at least once every 45 days. The chair of the CC will be the chief medical officer, or a designee designated in collaboration with the vice president of Medical and Credentialing Policy (the Chair of the CC). The CC will consist of at least two participating practitioners, one of whom practices in the specialty type that most commonly delivers services to Company members and falls within the scope of the credentialing programme, with no other role in Company network administration.

Initial Credentialing

Each practitioner or HDO must complete a standard application form when applying for initial participation in one or more of Anthem’s networks or Plan programs. It may be a state-mandated form or a standard form created by or deemed acceptable by Anthem: For practitioners, the Council for Affordable Quality Healthcare (CAQH), a Universal Credentialing Data source is utilized. To learn more about CAQH, visit their website at www.CAQH.org. All verifications must be current and verified within the 180 calendar day periods before the CC making its credentialing recommendation or as otherwise required by applicable accreditation standards.

Credentialing Criteria

To be eligible for initial participation in Anthem programmers or networks, all health care practitioners must meet the following criteria within the framework of the Anthem Credentialing Program:

• Submission of a full application and needed additions that must not include intentional misstatements

• Certificate attestation confirmed date within 180 calendar days of the date of submission to the CC for a vote

• Primary reference confirmations within adequate timeframes of the date of submission to the CC for a vote, as deemed by appropriate accrediting companies

• No sign of potential material omission(s) on form

• Current, accurate, free license to exercise in each state in which the practitioner would provide care to marked individuals

• No current license action

• No history of licensing committee action in any state

• No current federal ban and no history of federal sanctions (per System for Award Management (SAM), OIG and OPM report nor on NPDB report)

• Have a current, valid, unencumbered, unrestricted, and non-probationary license in the state(s) where they offer Anthem member’s services.

• A complaint may be made to this demand for applicants whose licensure work was related to substance abuse and who have shown a least two years of successful cooperation in a manner and monitoring plan; if this exemption is granted, the Plan may request specific documentation from the treating physician and program as it deems appropriate.

• Have a current, valid, and unrestricted Drug Enforcement Administration (DEA) and Controlled Dangerous Substances (CDS) registration for prescribing controlled substances; they would treat Anthem members if suitable to the work.

• Must not be barred or excluded from participating in any of the following programs: Medicare, Medicaid, or the Federal Employees Health Benefits Program (FEHBP).

Re-credentialing

The re-credentialing process includes re-verification and the Identification of differences in the practitioners or HDO’s:

• Licensure

• Sanctions

• Certification

• Health status

• The performance data (including, but not limited to, negligence

Experience, hospital right or other actions) that may indicate on the Practitioner’s or HDO’s professional conduct and support

All applicable practitioners and HDOs in the network within the range of Anthem Credentialing Program is expected to be credentialed every three years unless asked by agreement or state laws.

Anthem Credentialing Phone number

Furthermore, any colleague, health care professional, or business partner who has ideas or comments on how to preserve ethical behavior or identify and avoid fraudulent or unlawful behavior can contact the Ethics Office or phone the Helpline. Please contact KY National Provider Solutions (NPS) at 800-205-5870 if you have any contract questions.

Anthem Enrollment Application

You will be directed to apply online with all of your already obtained credentials. Every entity you enter will be examined and verified. It includes several identifying pre-requisite options for marking and verifying your credibility. As a result, they will double-check all of your information and keep you informed of the status of your ongoing procedures and progress at https://www.anthem.com/forms/

Anthem Enrollment Email

info@anthempress.com.

The above-mentioned email address and phone number can also be used to confirm eligibility status, benefits, and common questions.