Anthem Elevance for Treatment Centers

Anthem

Anthem, Inc. (operating as Elevance Health)

Anthem is the largest BCBS licensee in the U.S., operating under Elevance Health with behavioral health managed by Carelon.

Quick Reference

Payer Type

National Commercial

Parent Company

Elevance Health

Headquarters

Indianapolis, IN

BH Division

Carelon Behavioral Health

Provider Portal

Open Portal

Portal Guide

View Guide →

Credentialing

CAQH ProView

Timeline

90-120 days

Coverage

1 states

Last Verified

Mar 15, 2026

Published

Mar 15, 2026

Reading Time

12 min

Covered Levels of Care

• Medically Managed Detoxification
• Residential Treatment
• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
• Outpatient Treatment

Medical Necessity Criteria

• ASAM Criteria (for substance use disorders)
• InterQual (for mental health and medical necessity)

Streamline payer billing?

Overview

Anthem is the largest Blue Cross Blue Shield (BCBS) licensee in the United States, operating health plans in 14 states under the Anthem Blue Cross, Anthem Blue Cross Blue Shield, and related brand names. Anthem’s parent company, Elevance Health (formerly Anthem, Inc.), is one of the largest health benefits companies in the country, serving approximately 47 million medical members as of 2025 through its affiliated health plans, including commercial, Medicare Advantage, Medicaid, and Federal Employee Program products.

Behavioral health services for Anthem members are managed through Carelon Behavioral Health, the behavioral health subsidiary of Elevance Health. Carelon was formerly known as Beacon Health Options and handles utilization management, prior authorization, concurrent review, and clinical appeals for mental health and substance use disorder services. This carve-out arrangement means treatment centers interact with Carelon for clinical authorization decisions while working with Anthem’s provider network systems for credentialing and claims.

For treatment center operators, Anthem’s scale and geographic reach make it a major payer in many markets. However, the relationship between Anthem, its state-specific health plans, and Carelon Behavioral Health can create complexity in provider operations. Understanding which entity handles which function and recognizing that processes may vary by state are essential for managing Anthem patients efficiently.

Behavioral Health Coverage

Anthem covers behavioral health services across the full spectrum of care, including medically managed detoxification, residential treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP), and standard outpatient treatment. The specific benefits available to any given member depend on their plan design, which varies by employer group, individual plan selection, and whether the member is enrolled in a commercial, Medicare Advantage, or Medicaid managed care product.

Medical necessity for substance use disorder services is determined using the ASAM Criteria, while mental health services are evaluated using InterQual criteria. InterQual is a widely recognized evidence-based clinical decision support tool that provides standardized criteria for determining the appropriate level and intensity of care. Carelon Behavioral Health reviewers apply both frameworks during authorization reviews, and documentation that clearly maps to the relevant criteria dimensions significantly improves the likelihood of approval.

Anthem’s Medicaid managed care plans deserve special attention, as these plans follow state-specific Medicaid benefit designs that may differ substantially from commercial plan benefits. Covered levels of care, authorization requirements, and reimbursement rates for Medicaid plans are determined by each state’s Medicaid program. Treatment centers serving Anthem Medicaid members should familiarize themselves with the applicable state Medicaid behavioral health coverage rules.

Credentialing and Provider Enrollment

Anthem uses CAQH ProView as its credentialing verification source and Availity as its primary provider transaction platform. To initiate credentialing, complete your CAQH ProView profile and submit a network participation request through Availity or by contacting Anthem’s provider enrollment team for the specific state where you operate.

The credentialing process for Anthem typically takes approximately 90 to 120 days, though timelines can vary based on application volume and completeness. This extended timeline generally reflects both the volume of applications Anthem processes and the thoroughness of its verification procedures. Start the credentialing process well in advance of when you plan to accept Anthem patients to avoid gaps in network participation.

Required documentation includes current state facility licenses, individual clinical staff licenses and certifications, professional liability insurance certificates meeting Anthem’s minimum requirements, accreditation documentation from CARF or the Joint Commission, DEA registrations for prescribing providers, organizational NPI, a completed W-9, tax identification documentation, a current program description with staffing information, and evidence of compliance with applicable state regulations.

Because Anthem operates as the BCBS plan in 14 states, you must credential separately with each state’s Anthem plan where you intend to serve members. Credentialing with Anthem Blue Cross in California, for example, does not automatically credential you with Anthem Blue Cross Blue Shield in Indiana. Each state plan maintains its own provider network, though the credentialing process and requirements are largely consistent across states.

Recredentialing generally occurs every 36 months. Maintain your CAQH ProView attestation every 120 days and notify Anthem promptly of any changes to ownership, location, licensure, or key clinical personnel.

Verification of Benefits (VOB)

Benefits verification for Anthem members can be performed through the Availity portal, by calling the Anthem provider services number on the member’s insurance card, or through EDI 270/271 electronic eligibility transactions via your clearinghouse.

During a VOB, confirm the following: active coverage and effective dates, whether behavioral health benefits are included in the plan, specific levels of care covered for mental health and substance use disorders, deductible amounts and year-to-date status, coinsurance or copay requirements by level of care, out-of-pocket maximum and current accumulations, any day or visit limitations on behavioral health services, prior authorization requirements and the entity responsible for authorization (Anthem or Carelon), whether the member has out-of-network benefits, and whether the member’s plan is a commercial, Medicare Advantage, or Medicaid product.

Pay attention to the member ID prefix on the insurance card, as this often indicates the specific Anthem state plan and product type. Different prefixes may route to different authorization and claims processing systems. When in doubt, call the number on the back of the member’s card for the most accurate benefit information.

Document all VOB interactions including date, time, reference number, and representative name. For members with Anthem Medicaid plans, verify benefits through Anthem’s Medicaid-specific provider services line, as benefit structures and authorization processes differ from commercial plans.

Prior Authorization Requirements

Prior authorization is required for detoxification, residential treatment, partial hospitalization, and intensive outpatient programs. Authorization requests are reviewed by Carelon Behavioral Health clinical staff using ASAM Criteria for substance use disorder services and InterQual for mental health services.

Submit prior authorization requests through Availity, by calling the Carelon Behavioral Health authorization line, or through electronic prior authorization platforms. The submission should include a comprehensive biopsychosocial assessment, DSM-5 diagnoses, the recommended level of care with clinical justification, a treatment plan with measurable and time-bound goals, and documentation addressing all relevant ASAM dimensions or InterQual criteria points.

For emergency or urgent admissions, generally notify Carelon within 24 to 48 hours, though specific notification windows may vary by plan. Failure to obtain prior authorization or provide timely notification may result in reduced reimbursement or denial of the claim.

Concurrent review is required at regular intervals throughout the authorized episode of care. For residential treatment, concurrent reviews typically occur every 5 to 7 days. For PHP, reviews are generally conducted every 7 to 14 days. For IOP, concurrent reviews may occur every 2 to 4 weeks. Each concurrent review requires updated clinical documentation demonstrating continued medical necessity, patient progress, and the treatment plan going forward.

If an authorization is denied or reduced, request a peer-to-peer review between your treating clinician and the Carelon medical director. Peer-to-peer reviews should be requested promptly, within the timeframe specified in the denial notification. If the peer-to-peer does not resolve the issue, file a formal written appeal with supporting clinical documentation within the applicable deadline, which is generally 180 days but may vary by state and plan type.

Claims and Billing

Anthem accepts claims through electronic submission via clearinghouses (837I for institutional, 837P for professional) and through the Availity portal. Paper claims are accepted on UB-04 forms for institutional claims and CMS-1500 for professional claims. Electronic submission is strongly preferred and results in faster processing.

Timely filing limits for Anthem commercial plans typically range from approximately 90 to 180 days from the date of service, depending on the state and specific plan. Medicaid managed care plans follow state-specific timely filing requirements, and Medicare Advantage plans follow CMS guidelines. Always verify the applicable timely filing deadline for the specific plan to avoid preventable denials.

Ensure all claims include the authorization reference number for services that required prior authorization. Claims without valid authorization numbers will be denied. Verify that diagnosis codes, procedure codes, revenue codes, and units of service are accurate and consistent with the authorized services and clinical documentation.

Common denial reasons with Anthem include lack of prior authorization, medical necessity not established, timely filing exceeded, coding errors, non-credentialed rendering provider, and coordination of benefits discrepancies. Review each denial carefully and address the specific reason code in your corrective action or appeal.

The appeal process generally includes multiple levels of internal appeal, with specific procedures and timeframes varying by state. First-level appeals should typically include a cover letter identifying the denial reason and your grounds for appeal, along with all supporting clinical documentation. After exhausting internal appeals, external review by an independent review organization is generally available for adverse medical necessity determinations.

Payer Operations Quick Reference

The defining operational fact about Anthem: two entities answer the phone. Anthem (the state health plan) owns the network, credentialing, eligibility, and claims; Carelon Behavioral Health owns behavioral health authorization, concurrent review, and clinical appeals. Calling the wrong entity wastes hold time — this table says which one answers what. Numbers vary by state plan; confirm against the state provider manual at anthem.com ↗ and availity.com ↗ before relying on any value.

Provider phone numbers — which entity answers what

Phone-tree shortcuts are intentionally omitted: we only publish IVR navigation verified first-hand with a date.

Payer IDs and EDI

• Anthem payer IDs are state-specific — each state Anthem entity has its own ID, sometimes split professional vs. institutional.
• Match the member ID prefix and state plan against your clearinghouse payer list; a neighboring state’s Anthem ID is a rejection, and the rejection does not pause the filing clock.
• Behavioral claims generally go to Anthem’s payer ID even though Carelon authorized the care — the carve-out splits UM from claims. ERA/ 835 and EFT enrollment run through Availity.

Timely filing limits

Cross-payer table: /denial-code-timely-filing.

Claims and appeals addresses

• Electronic first: 837P/837I via clearinghouse or Availity under the state plan’s payer ID; paper claim addresses are state- and plan-specific — use the member ID card.
• Appeals: clinical BH denials are appealed through Carelon (peer-to-peer first, then written appeal, generally within ~180 days, state variation); administrative denials through Anthem at the address on the remittance. Expedited review applies while the patient is in active treatment at detox/residential/PHP/IOP.

Credentialing contacts

• CAQH ProView ↗ + participation request via Availity or the state plan’s enrollment team; credential separately in each of the 14 Anthem states; recredentialing every 36 months. See insurance credentialing.

Prior-auth quirks for behavioral health levels of care

Operational data last reviewed 2026-06-11; quarterly re-verification cadence applies. See /rcm for how automates the Anthem/Carelon split — eligibility via Availity, Carelon review tracking, and state-correct claim routing.

• Detox, residential, PHP, and IOP all require prior authorization through Carelon (ex-Beacon — see Carelon Behavioral Health for the entity’s own operations detail, and Beacon Health Options for legacy context).
• Concurrent review cadence: roughly every 5–7 days residential, 7–14 days PHP, 2–4 weeks IOP; urgent admissions need Carelon notification within 24–48 hours.
• Criteria: ASAM Criteria for SUD; InterQual for mental health.
• Facility claims bill 837I/UB-04 to Anthem with the Carelon authorization number on the claim — a missing auth number is an automatic denial even when the auth exists.

Frequently Asked Questions

Anthem is the largest licensee of the Blue Cross Blue Shield (BCBS) Association, operating BCBS plans in 14 states as of 2025. In 2022, Anthem's parent company rebranded to [Elevance Health](https://www.elevancehealth.com), though health plan operations generally continue under the Anthem and BCBS brand names. In states where Anthem operates, it typically functions as the local BCBS plan. In states where Anthem does not operate, other independent BCBS licensees provide coverage. Treatment centers must generally credential with each BCBS entity separately, as they are independent organizations.

Carelon Behavioral Health, formerly known as Beacon Health Options, is the behavioral health subsidiary of Elevance Health that generally manages utilization review, prior authorization, and clinical oversight for most Anthem members' behavioral health benefits. When you submit a prior authorization request for an Anthem member, it is typically routed to Carelon for clinical review. Carelon generally uses ASAM Criteria for substance use disorders and InterQual criteria for mental health determinations, though specific criteria may vary by plan. Credentialing and claims typically remain with Anthem's provider network systems. Verify current arrangements with [Anthem provider services](https://www.availity.com).

Anthem generally requires prior authorization for residential treatment, partial hospitalization, intensive outpatient programs, and detoxification services, though specific requirements may vary by plan and state. Requests are typically reviewed by Carelon Behavioral Health using ASAM Criteria for SUD and InterQual for mental health. Submit a clinical assessment, DSM-5 diagnoses, treatment plan, and level-of-care justification through [Availity](https://www.availity.com) or by calling the Carelon authorization line. Concurrent reviews are generally required at regular intervals, typically approximately every 5 to 7 days for residential and every 7 to 14 days for PHP, though intervals can vary.

Yes, Anthem's specific processes can vary by state due to differences in state insurance regulations, Medicaid program requirements, and local network arrangements. Authorization timeframes, appeal deadlines, provider enrollment procedures, and even the specific Carelon contact numbers may differ between states. Always check the state-specific provider manual and contact information for the Anthem plan in the state where you provide services, as requirements are subject to change. The member's insurance card will indicate which state plan applies.

Anthem credentialing typically takes approximately 90 to 120 days, though timelines can vary based on application volume, completeness, and regional factors. The process generally requires a complete CAQH ProView profile and submission of a participation request through Availity or directly to Anthem's provider enrollment team. Required documents typically include facility licenses, staff credentials, malpractice insurance, accreditation certificates, and organizational NPI, though specific requirements may vary. Anthem may conduct site visits for residential and detox facilities. Plan for this extended timeline when building your payer network.

Anthem provider services numbers vary by state plan — there is no single national line. Use the provider services number on the member's ID card, which routes to the correct state plan. Behavioral health authorization questions route to Carelon Behavioral Health, not Anthem, and the Carelon number also varies by state and plan. Availity chat and the state-specific provider manual at anthem.com list current numbers.

Anthem payer IDs vary by state plan — each state's Anthem entity has its own electronic payer ID, and some differ between professional and institutional claims. Match the member's ID prefix and state plan against your clearinghouse payer list before submitting. Defaulting to another state's Anthem payer ID is a common rejection cause.

Anthem commercial timely filing typically ranges from approximately 90 to 180 days from the date of service depending on the state and contract. Medicaid managed care and Medicare Advantage products follow state and CMS rules respectively. Check the state-specific provider manual and your participation agreement for the controlling deadline.

Related Payers

Key Billing Concepts

Revenue Cycle Resources

This guide is provided for informational purposes only and does not constitute legal, regulatory, or professional advice. Payer requirements, phone numbers, and portal URLs are subject to change. Always verify current information directly with the payer. is not affiliated with the insurance companies described on this page.

• Provider Portal
• Billing Hub
• Code Directory
• RCM Software

Reference tables

Common questions

Official sources

• anthem.comanthem.com