Anthem BCBS of New York for Behavioral

• AB
• Blue Cross Blue Shield

Anthem BCBS of New York

Anthem Blue Cross Blue Shield of New York

Anthem BCBS of New York (formerly Empire BCBS) is Elevance Health's NY licensee, covering millions through commercial, Medicare Advantage, and Medicaid plans.

Quick Reference

Payer Type

Blue Cross Blue Shield

Parent Company

Elevance Health

Headquarters

New York, NY

BH Division

Carelon Behavioral Health

Provider Portal

Open Portal

Portal Guide

View Guide →

Credentialing

CAQH ProView

Timeline

60-120 days

Coverage

1 states

Last Verified

Apr 19, 2026

Published

Apr 19, 2026

Reading Time

8 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)
• Carelon Behavioral Health clinical guidelines (for mental health)

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Overview

Anthem Blue Cross Blue Shield of New York is the Blue Cross Blue Shield licensee serving New York state, providing coverage to millions of members through commercial employer-sponsored plans, individual marketplace products, Medicare Advantage, and New York Medicaid managed care. Anthem BCBS NY is a subsidiary of Elevance Health (formerly Anthem, Inc.), the largest BCBS licensee in the United States by membership, and participates in the national Blue Cross Blue Shield Association ↗ and BlueCard inter-plan program.

Empire BCBS legacy: Prior to October 2023, this entity operated under the name Empire Blue Cross Blue Shield. The trade-name transition to Anthem Blue Cross Blue Shield was part of Elevance Health’s broader strategy to align its BCBS subsidiaries under the Anthem brand, which it has carried out across multiple states over several years. The underlying legal entity, BCBS licensee status, provider contracts, and authorization systems were unchanged by the rebrand. Providers who had long-standing relationships with Empire BCBS continue those relationships under the Anthem BCBS of New York name. Members and providers searching for “Empire Blue Cross” will find the same organization now operating as Anthem BCBS of New York.

A critical operational distinction for behavioral health providers: Anthem BCBS of New York routes behavioral health utilization management — including prior authorization, concurrent review, and case management — through Carelon Behavioral Health, Elevance Health’s managed behavioral health subsidiary (formerly known as Beacon Health Options before its 2023 rebrand). When submitting behavioral health authorization requests for Anthem BCBS NY members, the authorization contact is Carelon Behavioral Health, not Anthem’s medical authorization line.

Behavioral Health Coverage

Anthem BCBS of New York covers behavioral health services across the full continuum of care: medically managed detoxification, residential treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP), and standard outpatient therapy and medication management. Specific cost-sharing, benefit limits, and in-network requirements vary by plan design and employer group.

Behavioral health utilization management is handled by Carelon Behavioral Health on behalf of Anthem BCBS NY. Medical necessity determinations for substance use disorder treatment are based on the ASAM Criteria. For mental health services, Carelon applies its own proprietary clinical guidelines, which are reviewed and updated periodically. Treatment centers should align SUD documentation with ASAM Criteria across all six dimensions, and mental health documentation with Carelon’s published clinical guidelines.

New York has particularly strong behavioral health parity and access requirements. Fully insured commercial plans are subject to New York Insurance Law Section 3221 and Mental Hygiene Law parity provisions, which restrict financial and treatment limitations on behavioral health care. Timothy’s Law establishes minimum coverage standards for mental health treatment. When an authorization is denied and the restriction appears to violate New York parity law, citing the specific statutory provision in the appeal letter activates state-level protections and review mechanisms not available in federal MHPAEA alone.

Credentialing and Provider Enrollment

Anthem BCBS of New York uses CAQH ProView as its primary credentialing verification source for individual practitioners, consistent with Elevance Health’s credentialing approach across its BCBS subsidiaries. Before initiating participation, ensure your CAQH ProView profile is complete, fully attested, and authorizes Anthem BCBS NY access. Individual clinical staff must maintain current New York State licensure from the appropriate professional licensing board.

Facility-level credentialing for behavioral health programs requires supplemental documentation: current New York State facility licensure — from the Office of Alcoholism and Substance Abuse Services (OASAS) for SUD programs, or the Office of Mental Health (OMH) for mental health programs — accreditation from CARF or The Joint Commission, professional liability insurance, organizational NPI, completed W-9, program descriptions with staffing models, and clinical staff rosters.

Credentialing timelines typically range from 60 to 120 days from a complete submission. Common delays include incomplete CAQH profiles, expired state licensure, or gaps in behavioral health carve-out enrollment with Carelon. When credentialing to treat Anthem BCBS NY members for behavioral health, confirm whether facility enrollment with Carelon Behavioral Health is required separately from Anthem’s medical network enrollment. Some behavioral health credentialing processes require parallel enrollment with both Anthem and Carelon.

Recredentialing occurs approximately every 36 months. Maintain CAQH attestation every 120 days and report material changes to ownership, licensure, or clinical leadership promptly.

Verification of Benefits (VOB)

Benefits for Anthem BCBS of New York members can be verified through Availity (Anthem’s designated provider transaction platform), by calling the provider services number on the member’s insurance card, or through EDI 270/271 eligibility transactions via your clearinghouse.

The three-character alpha prefix on the member’s BCBS ID card identifies the home plan. For Anthem BCBS NY-issued cards, benefits are governed by Anthem’s plan design. When a BCBS member from any other state presents at a New York facility, the BlueCard program applies: submit the claim to Anthem BCBS NY as the host plan, and Anthem routes it through BlueCard to the home plan for adjudication. The home plan’s benefits and authorization requirements govern — including whether the home plan has its own behavioral health carve-out arrangement distinct from Carelon. Always contact the home plan directly before admission to confirm coverage and obtain authorization.

For every VOB, document: coverage status and effective dates, behavioral health benefit availability, covered levels of care for MH and SUD, deductible and out-of-pocket accumulations, coinsurance or copay by level of care, day or visit limits, prior authorization requirements and the responsible entity (Carelon or the home plan’s BH manager), any carve-out arrangement, and out-of-network benefit availability. Record reference numbers, date, time, and representative name for every verification.

Prior Authorization Requirements

Anthem BCBS of New York routes behavioral health prior authorization to Carelon Behavioral Health. Prior authorization is generally required for residential treatment, partial hospitalization, intensive outpatient, and medically managed detoxification. Standard outpatient services typically do not require authorization for in-network providers, though some plan designs include notification requirements.

Authorization requests should be submitted to Carelon Behavioral Health before admission. For emergency admissions, notification must generally be provided within 48 hours. SUD authorization documentation must address all six ASAM dimensions with specificity. Mental health authorization documentation should align with Carelon’s clinical guidelines for the proposed level of care.

Concurrent review for residential treatment typically occurs every 5 to 7 days. PHP concurrent reviews are generally scheduled every 7 to 14 days. IOP reviews typically occur every 2 to 4 weeks. Document each concurrent review contact with date, reference number, reviewer name, and decision. If a request is denied, request peer-to-peer review promptly through Carelon and document the outcome.

New York’s utilization review regulations provide specific appeal rights and timeframes, including requirements for expedited review for urgent clinical situations. Cite applicable New York Insurance Law and Mental Hygiene Law provisions in appeals when denials appear to conflict with parity obligations.

Claims and Billing

Anthem BCBS of New York accepts electronic claims in 837I (institutional) and 837P (professional) formats through Availity or your clearinghouse. Paper claims use UB-04 for institutional services and CMS-1500 for professional services. Electronic submission is strongly preferred.

Confirm the correct Anthem BCBS NY payer ID for the member’s product line (commercial, Medicare Advantage, Medicaid) with your clearinghouse. Elevance Health operates multiple BCBS entities, each with its own payer IDs by state and line of business. For BlueCard claims involving out-of-state BCBS members, submit to the Anthem BCBS NY payer ID as the host plan.

Timely filing limits for Anthem BCBS NY commercial plans typically range from 90 to 180 days from the date of service, though some plans allow up to 365 days. Verify your specific contracted deadline. Claims submitted after the filing limit are typically non-appealable. Always include the Carelon authorization reference number on behavioral health claims for authorized services.

Key Contact Information

• Provider Portal: https://www.availity.com ↗ (Anthem’s designated provider transaction platform)
• Carelon Behavioral Health: https://www.carelonbehavioralhealth.com ↗ (behavioral health authorization and UM)
• Credentialing: CAQH ProView ↗ for individual practitioners; contact Anthem BCBS NY provider enrollment and confirm Carelon enrollment requirements
• Prior Authorization (Behavioral Health): Submit to Carelon Behavioral Health through Availity or the member’s insurance card behavioral health number
• Verification of Benefits: Availity, EDI 270/271 via clearinghouse, or call provider services on the member’s card
• Claims Submission: Electronic via Availity or clearinghouse; confirm Anthem BCBS NY payer ID by product line
• BCBS Association Directory: https://www.bcbs.com ↗ to identify home BCBS plans for BlueCard members

Frequently Asked Questions

Empire Blue Cross Blue Shield was the long-standing brand name for the BCBS licensee serving New York. Effective October 2023, Empire BCBS completed a trade-name transition to Anthem Blue Cross Blue Shield, aligning with Elevance Health's national brand consolidation strategy across its BCBS licensee subsidiaries. The underlying legal entity, licensee status, and provider contracts remained the same — only the consumer-facing and provider-facing brand name changed. If your facility had a contract with Empire BCBS, that contract continues in force under Anthem BCBS of New York. Provider portal access, credentialing records, and billing systems carried over. Existing authorizations issued under the Empire name remain valid.

Anthem BCBS of New York routes behavioral health utilization management — including prior authorization, concurrent review, and case management — through Carelon Behavioral Health, Elevance Health's managed behavioral health subsidiary. Prior authorization is generally required for residential treatment, partial hospitalization, intensive outpatient, and medically managed detoxification. Submit authorization requests to Carelon Behavioral Health through Availity or by calling the behavioral health number on the member's insurance card. Documentation should address ASAM Criteria for SUD and Carelon's clinical guidelines for mental health. Concurrent reviews for residential care typically occur every 5 to 7 days. New York's behavioral health parity laws apply to fully insured plans and provide additional appeal protections.

The BlueCard program allows BCBS members to receive covered services outside their home plan's service area. When a patient presents a BCBS card from any plan other than Anthem BCBS of New York, the three-character alpha prefix on the member ID identifies the home plan. New York providers submit claims to Anthem BCBS NY as the host plan, and Anthem routes the claim through BlueCard to the home plan for adjudication. Benefits and authorization requirements are governed by the home BCBS plan. Always contact the home plan directly before admission to confirm coverage, obtain authorization, and document reference numbers. For BlueCard behavioral health, the home plan's BH carve-out arrangement — not Carelon — may govern authorization.

Anthem BCBS NY uses CAQH ProView as its primary credentialing platform for individual practitioners, consistent with Elevance Health's credentialing approach across its BCBS subsidiaries. Ensure your CAQH ProView profile is complete, attested, and authorizes Anthem BCBS NY access. Facility credentialing for behavioral health programs requires: current New York State facility licensure (from OASAS for SUD programs or OMH for mental health), CARF or Joint Commission accreditation, professional liability insurance, organizational NPI, W-9, program descriptions, and staffing rosters. Timelines typically run 60 to 120 days from a complete submission. Recredentialing occurs every 36 months. Report material changes to licensure, ownership, or clinical leadership promptly.

Yes. New York has strong behavioral health parity protections under Insurance Law Section 3221(l)(5) and Mental Hygiene Law, which apply to fully insured commercial plans. New York's parity requirements include specific provisions addressing residential and intensive outpatient behavioral health treatment. New York also enacted Timothy's Law (2006) and subsequent amendments that impose minimum coverage standards for mental health services. The state's prior authorization reforms under the 2022 Surprise Billing and Consumer Protection laws further restrict certain prior authorization practices for fully insured plans. Self-funded employer plans are governed by federal MHPAEA. Cite applicable New York statutes in appeal letters to strengthen the regulatory basis of your arguments.

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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.

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Official sources

• Blue Cross Blue Shield Associationbcbs.com