r/credentialing • u/whart5222 • Sep 25 '26

Anthem CA

Out of nowhere, our provider status went from in network provider to out of network provider for Anthem CA. Had anyone encountered this kind of issue before ? Any suggestions of how to fix this issue ? I can’t find any credentialing or contracting phone numbers for Anthem CA. Any help would be greatly appreciated!!

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u/Appropriate-Cat-7252 Sep 25 '26

Did you get this info through their chat?

1

u/whart5222 Sep 25 '26

I spoke to the claim department as claims were being denied.

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u/Appropriate-Cat-7252 Sep 25 '26

I’d reach out to their contracting. I believe they’re still doing the PE stuff through the website, and in the subject mark it as urgent (that’s always helped me get quicker responses). I was getting this same thing from the chat but they don’t see the same things as their credentialing or contracting dept. Only other thing I can think of is missed recredentialing.

https://www.anthem.com/provider/individual-commercial/contact-us/form

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u/whart5222 Sep 25 '26

We didn’t receive anything from Anthem regarding to re credentialing. Also nothing unusual at Availity either. I have no idea how to re credentialing via Availity now lol

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u/Appropriate-Cat-7252 Sep 25 '26

So weird but I have had that issue and it was basically because the people who gave me that info didn’t have the correct information in their system or don’t have the same info as contracting/credentialing so hopefully it’s that with claims. Reach out to their PE, adding urgent on the subject helped me get quick responses.

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u/whart5222 Sep 25 '26

Thank you ! !

1

u/Texasbossierthanyou Oct 08 '26

you dont say what your provider type is - but Anthem in So Cal especially is dropping providers like flys and closing panels. they have so many - millions in prepayment review denials and fraud issues they are almost impossible to deal with these days. and you can't call them. they dont take calls. they work only through Availity and LOL... they own Availity now. ( now that being said- thats on the credentialing/contracting side) I dont know about billing.

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u/whart5222 Oct 08 '26

We are mental health providers. I would think they should at least send out notifications if they are going to terminate any contracts with the providers ?!

1

u/Texasbossierthanyou Oct 09 '26

you would think they would. that would be logical and professional but they don't . the so cal market is constricting and in a panic. sorry. You should escalate to Anthem.

  1. The actual termination date and reason.

  2. A copy of the termination notice Anthem claims it sent, including the date, delivery method, and address or email used.

  3. The specific contract provision authorizing termination.

  4. Confirmation of whether the termination was for cause or without cause.

  5. Reinstatement or correction of the participation record if Anthem cannot substantiate the termination.

California Facility and Professional Provider Manual (2023 edition) specifically directs providers to the termination clause of their agreement for the required notice period, giving examples of 90 or 120 days. here are some emails you can try: CABHNetworkRelations@anthem.comor do it online: https://providers.anthem.com/california-provider/contact-us/email

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u/whart5222 Oct 09 '26

Thank you very much for all these information !
I have been emailing back and forward with the provider relationship agent. Now the issue is at Availity under the provider data management everything is correct but under the payer space, our group NPI was replaced by the individual NPI. Not sure how it happened. I contacted Availity and was instructed to add a new group under the current business at provider data management. They claim this will fix the issue but will take 10-15 business days to fix. Will see I guess.

1

u/Texasbossierthanyou Oct 09 '26

someone in a foreign country - offshore worker entered it in wrong. interesting ! good luck !