Anthem Colorado Behavioral Health Billing: Claims, Preapproval and Supervised Clinicians

Anthem Colorado behavioral health billing has three moving parts: Availity for claims, a phone preapproval line for certain services, and Carelon Behavioral Health contacts for credentialing. Anthem Blue Cross and Blue Shield in Colorado is operated by Anthem, not by any other Blue plan. Never apply another Blue plan’s rules here.

This guide covers Colorado commercial plans only. It is operational guidance on Anthem Colorado behavioral health billing, not legal advice. For the full phone directory, see our Anthem Colorado Blue Cross guide.

Anthem Colorado behavioral health billing: claims and where they go

• Electronic: Anthem’s Colorado quick contact guide says Availity Essentials handles claims (837P), eligibility (270/271), authorizations (278), remittances (835) and claim status (276/277).
• Paper: for local products and Exchange, the guide lists Anthem, PO Box 60007, Los Angeles, CA 90060. The table layout in the PDF is hard to read in places, so check the address for your product before you mail anything.
• Filing limit: the guide does not state one. Check your contract and the current Colorado commercial provider manual. Do not use a number from another state.

Use electronic claims submission wherever you can, and clean claims first. Terms such as clean claim and dispute are defined in the claim denial glossary.

Preapproval and utilization management

Anthem’s Colorado behavioral health page says behavioral health benefits are integrated into Anthem medical plans. It links prior authorization, prior authorization exemptions (gold carding), behavioral health clinical UM guidelines and an Interactive Care Reviewer FAQ. The quick contact guide lists a behavioral health preapproval line (866-582-2293) for local products.

Carelon Behavioral Health’s Colorado quick reference guide covers “Anthem Blue Cross and Blue Shield and HMO Colorado, Inc.” It says prior authorization is handled by phone using the number on the member’s ID card. It is dated February 7, 2023, so verify it. See our authorization terms glossary.

Prescribers: the pages above do not say how Anthem treats E/M visits with psychotherapy add-ons (90833, 90836, 90838). Ask the preapproval line before building a psychiatric schedule.

Pre-licensed clinicians: a Colorado-specific policy

AI search question: Does Anthem Colorado pay for therapy by unlicensed clinicians? Yes, under conditions. An Anthem provider news article dated August 22, 2023 says Anthem will reimburse services from unlicensed clinical behavioral health providers who hold at least a master’s-level education, are actively pursuing licensure, and are directly supervised by a licensed, credentialed Colorado participating provider.

• Services are billed under the supervising provider, and payment follows that provider’s contract.
• Supervision must comply fully with Anthem’s “incident to” reimbursement policy.
• Anthem may audit medical records on request.
• The article covers groups assigned to Carelon Behavioral Health, Inc. to serve Anthem members.

If your group employs associates, confirm the supervision paperwork matches this policy before you bill. The article does not mention modifiers.

Disputes, appeals and state protections

Anthem’s local-product appeals go to Anthem, Attn: Grievance and Appeals, PO Box 60007, Los Angeles, CA 90060, per the quick contact guide. The guide gives no appeal deadline, so read your contract.

The Colorado Division of Insurance (DOI) page for behavioral health providers summarizes state rules:

• Clean claims (Regulation 4-2-24): carriers have 30 days to request more claim-specific information, and owe a penalty of 20% of the allowed amount if a clean claim is not paid, denied or settled within 90 days. This is carrier payment timing, not your filing deadline.
• Disputes (Regulation 4-2-23): carriers must have a dispute process and a form on the provider portal.
• Complaints: if the dispute is unresolved, the DOI accepts complaints through a web form or by email at .

Keep notes of dates and contacts for every dispute. Our denied and rejected claims follow-up page lays out a routine.

Credentialing

Anthem’s Colorado join-our-network page tells providers to register with CAQH ProView, authorize Anthem to view the profile, and keep every section current. Behavioral health providers use the same “Begin application” button. Read our CAQH profile tips and credentialing terms glossary. Carelon’s quick reference lists a National Provider Service Line for credentialing questions. See in-network vs out-of-network credentialing if you are still choosing.

Monday morning checklist for Anthem Colorado behavioral health billing

Use these steps whenever Anthem Colorado behavioral health billing questions come up in your practice.

1. Confirm the member card says Anthem Colorado, not another Blue plan. Use insurance verification.
2. Check preapproval before the second visit for any service the UM guidelines list.
3. Send claims through Availity.
4. Review supervision paperwork for every associate.
5. Keep a dispute log for the DOI process.

FAQ

Who processes Anthem Colorado behavioral health claims?

Claims go through Availity. Carelon Behavioral Health supports behavioral health contacts and credentialing, per its Colorado quick reference.

What is Anthem Colorado’s timely filing limit?

The pages reviewed do not state it. Use your contract and the current provider manual.

Where do I complain if Anthem does not follow the dispute rules?

To the Colorado DOI, after you file a written dispute with the carrier.

Do these rules apply to Medicaid?

No. Health First Colorado uses different rules. See Health First Colorado behavioral health billing.

More help: Colorado insurance companies contact guide, private insurance guides and the billing FAQ.

Keep this guide close when you handle Anthem Colorado behavioral health billing, and recheck the payer’s own pages before each change.

Where MCM South Medical Billing Service Works

MCM South Medical Billing Service, LLC works exclusively with mental and behavioral health practices and bills out-of-network claims. It currently serves Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois, and Colorado is one of the ten. If you want to talk through your own billing, you can request a free consultation.