Anthem Blue Cross Blue Shield New York Behavioral Health Billing: Carelon, CAQH and Prompt Pay
Anthem Blue Cross Blue Shield New York behavioral health billing is easier when you know three things: Anthem used to be Empire, its behavioral health network sits with Carelon, and New York law sets the payment clock. Anthem Blue Cross and Blue Shield is the downstate name for the plan that was Empire BlueCross BlueShield until January 1, 2024. This guide to Anthem BCBS New York behavioral health billing explains what that means for therapists and psychiatrists. It covers Anthem in New York only. Sources were checked on October 9, 2026.
Why this post covers Anthem
New York has more than one Blue Cross licensee. Our New York Blue Cross guide covers Anthem, Excellus and Highmark. They are separate companies with separate networks, so a rule for one does not apply to another. We start with Anthem because the Carelon arrangement changes where your agreement and authorizations live, and it is a common source of billing mix-ups. Provider phone numbers for all NY payers are in our New York insurance contact guide.
Empire became Anthem, and Carelon runs behavioral health
Per the guide, Empire BlueCross BlueShield became Anthem Blue Cross and Blue Shield on January 1, 2024. Old and new ID cards are both valid. Behavioral health has a second layer. In March 2023, Anthem’s New York provider news announced that Empire was assigning impacted behavioral health provider agreements to Carelon, formerly Beacon. The article covered commercial, Medicaid and Medicare Advantage plans. It said rates, clinical processes and claims processes were not changing at that time.
What should you do with that? Read your contract and your welcome letters. If your agreement was assigned, authorization and behavioral health questions may go to Carelon Behavioral Health, which lists a national provider services line at 800-397-1630. The page describes a provider portal, a handbook that covers credentialing and appeals, and medical necessity criteria.
How do I join Anthem’s network in New York?
Register or update your CAQH ProView profile, authorize Anthem to access it, make every section complete, and start the online application. Anthem’s Join Our Network page says it uses CAQH ProView for credentialing and lists behavioral health providers among those who apply online. A complete application needs items such as your signature, licenses, DEA or CDS certificates for prescribers, and five years of work history. Keep the CAQH Provider Data Portal current. Our CAQH profile setup post lists three common traps. For the full path, read our credentialing page and the credentialing and network status guide.
The page does not say whether Carelon takes part in behavioral health credentialing. Ask Anthem which entity credentials you before you bill.
Not sure you want to join? Our guide on credentialed vs noncredentialed status weighs the tradeoffs. MCM South also bills out-of-network claims for clients.
New York’s payment clock for insured plans
New York Insurance Law gives you timelines. Section 3224-a sets them for insurers:
| Rule | What the law says |
|---|---|
| Electronic claims | Pay within 30 days |
| Paper or fax claims | Pay within 45 days |
| Good-faith dispute | Pay the undisputed part and send a written notice within 30 calendar days |
| Notice content | Say whether the claim was denied or partly approved, give specific reasons, and say what information is needed |
| Interest | The greater of the corporate tax rate set by the state or 12% per year, from the date payment was due |
| Provider filing window | Submit within 120 days after the date of service to be valid and enforceable, unless the parties agree to terms more favorable to the provider |
The deadlines do not apply when the obligation to pay is “not reasonably clear” or when fraud is suspected. For illustration, a clean electronic claim received on March 1 is due by March 31 under the 30-day rule, while the same claim sent on paper is due by April 15. Your contract may be more generous than the law, so read it.
What if Anthem pays late? The DFS health insurance page points providers to a Prompt Pay Complaint in the DFS portal. Before you file, confirm Anthem received the claim and that the plan is insured. DFS says it lacks jurisdiction over self-funded plans and Medicare. Anthem’s own notice of its 120-day commercial filing limit dates from 2019, so confirm the limit in your contract.
Claim hygiene for Anthem BCBS New York behavioral health billing
Follow these steps to keep Anthem BCBS New York behavioral health billing clean.
- Verify benefits and the member’s plan type before the first session.
- Match the code to your license. Review the psychotherapy code guide. Psychiatrists should review diagnostic evaluation codes 90791 and 90792 and the add-on rules in their contract.
- Put the right modifier and place of service on telehealth claims. See our guide to telehealth modifiers 93 and 95.
- Log submission dates and confirmation reports so you can prove receipt.
- When a denial arrives, check its reason against the law’s notice requirements. Our denied claims service page shows the follow-up path.
Anthem BCBS New York behavioral health billing FAQ
Short answers on Anthem BCBS New York behavioral health billing follow.
Is Anthem NY the same as Empire?
Yes. Empire BlueCross BlueShield became Anthem Blue Cross and Blue Shield on January 1, 2024, per our Blue guide and Anthem’s notice.
Who manages Anthem NY behavioral health?
Anthem’s 2023 notice assigned impacted behavioral health agreements to Carelon. Check your own contract.
How fast must Anthem pay in New York?
Thirty days for electronic claims and 45 days for paper or fax, for insured plans, with interest on late payment.
Where do I complain?
DFS accepts prompt pay complaints from providers for insured plans.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service works with mental and behavioral health practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We work with psychotherapists and psychiatrists in solo and medium-size practices. If you run a New York practice and want help with Anthem billing, you can request a free consultation.
