How to Become an In-Network Provider for Anthem
Becoming an in-network provider for Anthem can be a significant step in expanding your healthcare practice and ensuring that your patients have access to the highest quality care. Anthem, one of the largest health insurance companies in the United States, has a rigorous process for credentialing providers. Here’s a comprehensive guide on how to become an in-network provider for Anthem.
1. Understand the Requirements
Before you begin the application process, it’s crucial to understand the requirements set by Anthem. These typically include:
– Being licensed and in good standing in the state where you practice.
– Having a current national provider identifier (NPI).
– Having malpractice insurance.
– Being in good standing with Medicare and Medicaid, if applicable.
2. Gather Required Documents
To apply for in-network status with Anthem, you will need to gather several documents. These may include:
– A completed provider application form.
– A copy of your current license.
– A copy of your NPI.
– A copy of your malpractice insurance policy.
– Any additional documentation required by Anthem, such as a DEA number or a certificate of insurance.
3. Complete the Online Application
Anthem provides an online application portal for providers to submit their credentialing information. To access the portal, you will need to create an account and follow the instructions provided. Be prepared to provide detailed information about your practice, including:
– Practice location and contact information.
– Practice type and specialty.
– Hours of operation.
– Services offered.
4. Wait for Credentialing Review
Once you have submitted your application and all required documents, Anthem will begin the credentialing review process. This process can take several weeks to several months, depending on the complexity of your application and the volume of applications Anthem is processing at the time.
5. Attend a Credentialing Interview
In some cases, Anthem may request an in-person or virtual interview to gather additional information about your practice. Be prepared to discuss your practice’s policies, procedures, and quality of care during this interview.
6. Maintain In-Network Status
After you have been approved as an in-network provider, it’s essential to maintain your status with Anthem. This includes:
– Continuing to meet all licensure and insurance requirements.
– Reporting any changes to your practice, such as a change in location or specialty.
– Adhering to Anthem’s billing and coding guidelines.
7. Stay Informed
Anthem regularly updates its credentialing requirements and policies. Stay informed about these changes to ensure that your practice remains in compliance with Anthem’s standards.
By following these steps, you can increase your chances of becoming an in-network provider for Anthem. Remember that patience and thorough preparation are key to a successful application process.
