Summary
Anthem is denying claims for members who have dual par status, instructing providers to submit directly to Anthem instead of through the intermediary. For Anthem of Connecticut members, practices must verify with Carelon whether a direct Anthem contract exists. Incorrectly denied claims will be compiled into a monthly report by Anthem for reprocessing, with newer claims prioritized.
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What to do
immediately · 5 steps
01Billing team must implement a verification process for all Anthem claims.
02For Anthem of Connecticut members, contact Carelon at Provider.Inquiry@carelon.com or 1-800-397-1630 to confirm whether the practice has a direct contract with Anthem of Connecticut.
03If direct contracts exist, route those claims directly to Anthem rather than through Carelon.
04For non-Connecticut Anthem members with claim denials citing direct Anthem contracts, monitor the monthly adjustment reports from Anthem and reconcile reprocessed claims.
05Update billing software routing rules to distinguish between Anthem members requiring direct submission versus those submitted through intermediaries.
If missed: Failure to route claims correctly will result in unnecessary denials and delays in reprocessing.
Original notice
Anthem Dual Par Issue
bcbsri.com · Always check the source before changing claims.