Who they are
Enroll with the correct state entity. Because Elevance holds the Blue license in specific states, its contracting entity varies by geography. A contract with one state’s Elevance-operated Blue is not a contract with another state’s — whether that other state’s Blue is Elevance-operated or an independent licensee.
This is the single most common enrollment error for groups expanding into an Elevance state. See BCBS Association.
Plan types on the card
Anthem Blue Cross, Anthem Blue Cross Blue Shield, and state-specific Blue branding; Medicare Advantage; Medicaid under state brands; and substantial self-funded ASO volume.Enrollment and credentialing
Provider transactions are largely conducted through Availity, which serves as the provider portal. Start there and at the state Blue’s own provider site. Credentialing generally pulls from CAQH.EDI, ERA, and EFT
- EDI — through your clearinghouse
- ERA and EFT — via the payer’s enrollment process; CAQH’s EFT/ERA tool participates for some payers
- Note that Availity is both a portal and a clearinghouse — using it as a portal does not require using it as your clearinghouse
Appeals
State-specific processes layered over the plan type. Determine whether the member is on a fully-insured or self-funded plan before choosing your argument.Quirks worth knowing
- Behavioral carve-out — Carelon Behavioral Health requires separate contracting
- Blue geography — BlueCard handles out-of-area members; it does not substitute for participating where you have an office
- Availity dependency — much of the operational surface runs through Availity