Anthem Blue Cross and Blue Shield
Credentialing and Provider
Maintenance
Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin ("BCBSWi") which underwrites or administers the PPO and
Stacy Smith
[email protected]
Agenda
• New providers
• Credentialing application
• Council for Affordable Quality Healthcare (CAQH) • Online provider maintenance form
• Approval notification
• Provider changes and terminations
• Tax Identification Number Change
New providers
• Providers requiring credentialing – Behavioral Health
• Facilities
• Acute Inpatient, Intensive Outpatient, Residential Treatment
• Professional
• Psychiatrist (MD), Psychologist (PhD, PsyD, EdD), Licensed Clinical Social Workers, Licensed
Professional Counselors, Licensed Marriage and Family Therapist, Advanced Practice Nurse
Prescribers (APNP)
New providers
• Providers exempt from credentialing – Behavioral
Health
• Professional
• Substance Abuse Counselor (SAC)
• Clinical Substance Abuse Counselor (CSAC) • Licensed Independent Clinical Social Worker
(LICSW)
New providers
• WI Autism Mandate – State Statute 632.895(12m) and
Senate Bill 667
• Requires coverage for evidence-based therapy services for individuals with Autism Spectrum disorders
• Certification forms required in addition to credentialing for providers delivering therapy services
• Certification forms available under Answers@Anthem – Provider forms faxed upon completion
New providers
• WI Autism Mandate – State Statute 632.895(12m) and Senate Bill 667 Continued
• Qualified specialty specific provider certification forms
• Psychiatrist, Psychologist, Behavioral Analyst or Licensed Social Worker Certification form for Intensive Level Services
• Psychiatrist, Psychologist, Behavioral Analyst or Licensed Social Worker Certification form for Non-Intensive Level Services
• Outpatient Mental Health Clinic Certification Form
• Autism Paraprofessional Certification Form (completed by supervising provider)
• Occupational Therapist and Speech Therapist Certification Form
New providers
• Credentialing Application – CAQH
• Required submission through Council for Affordable Quality Healthcare (CAQH)
• Meets URAC and NCQA data collection standards • Enter data once for all national Health Plans
• Practice Administrator Module • No cost to providers
New providers
• Credentialing Application – Approval
• Complete & Accepted by CAQH
• Online Provider Maintenance Form (PMF) Submission • Source Verification – Anthem
• Credentialing Committee Approval – Anthem
New providers
• Online Provider Maintenance Form (PMF)
• Available on our public website at Answers@Anthem under Provider Forms
• Enter provider information including CAQH ID if credentialing is required
• Print a copy for your records and submit • Electronic routing to Anthem
New providers
• Online Provider Maintenance Form (PMF)
• Starts the provider addition/registration process • Anthem provider registration confirmation
• Provider effective date 30 days from date completed submission is received by Anthem
• Routes data to Anthem Credentialing • Credentialing approval notification
Provider Changes and Terminations
• Demographic Changes
• Submit a Provider Maintenance Form
• Address Updates
• Submit a Provider Maintenance Form
• Terminations
• Submit a Provider Maintenance Form
Provider Changes and Terminations
• Tax Identification Changes
• Submit a Provider Maintenance Form • Contracts are not transferable
• Contact your Network Relations Consultant
Stacy Smith (715) 852-5647
Learn more
• Resource Tools on the Provider Education page of
anthem.com – See Web Meetings, April 2011
Behavioral Health Informational Provider Seminar
• Provider Additions & Maintenance Hand-Out • Sample Provider Affiliation Letter
• Sample Credentialing Approval Letter • CAQH Quick Reference Guide
• Additional training – Your Network Relations
Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin ("BCBSWi") which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively which underwrite or administer the POS policies. Independent
