Credentialing is the process Anthem uses to evaluate and select licensed independent practitioners to provide care to our members. Anthem uses the Council for Affordable Quality Healthcare (CAQH) ProView application for credentialing. This secure and private portal reduces the amount of paperwork you need to fill out to complete the credentialing process.
Credentialing Overview
Why do we credential?
Credentials are evaluated according to criteria set forth in our policy to ensure the competency and conduct of the health care professionals serving members in our network.
Who do we credential?
We credential licensed health care professionals with whom the company intends to contract and market to our members. Our Program Summary includes a complete list of provider types we credential and those we do not.
Please note: Facilities (Health Delivery Organizations) may also need to be credentialed before joining the network.
Credentialing Process
- Register with CAQH (if you are not already registered). You may self-register by visiting proview.caqh.org . This is a secure and private portal.
- Authorize Anthem so we can access your credentialing information. If you are already registered with CAQH, you will need to give us permission to review your information.
If you need assistance, please review the New Provider Quick Reference Guide or call the CAQH Provider help line at 1-888-599-1771.
- Review and update your application. Please ensure all sections of the application are complete and accurate.
- Your signature and application date
- CAQH status of “Initial Application Complete” or “Reattestation”
- Current license to practice in each state where services are provided
- Education/Training to support requested specialty(ies) (or documentation that provider will complete training within 60 days of application)
- Current Hospital Privilege information
- Current DEA or CDS certificate in each state where services are provided
- Explanations to questions on the application
- Five years’ work history, in month/year format
- Current Professional Liability Insurance
- Applicant must also allow a site review within 30 days of our request, if applicable
Recredentialing
Anthem recredentials network providers every three years. If your CAQH application is current and complete at that time, no additional effort on your part may be required. If CAQH is expired or missing information, we will contact you to update the information.
Non-response to Recredentialing Requests
If you do not update CAQH or supply the required information for recredentialing by the due date, your application will be considered incomplete and will result in an administrative termination from the network.
Provider Rights
Providers have the right to:
- Review information submitted to support their credentialing application
- Correct erroneous information
- Receive the status of their credentialing or recredentialing application upon request
For a complete list of your credentialing rights as a Provider, please review the Practitioner Credentialing Rights. To review your application or correct submitted information, please email our Credentialing team at Credentialing@Anthem.com.
