Anthem California Behavioral Health Billing: Claims, Disputes and Enrollment
Anthem California behavioral health billing has one rule that catches practices every year: professional claims have a short filing window. Anthem Blue Cross, also called Blue Cross of California and part of Elevance Health, is a different company from Blue Shield of California. Treat them as two payers.
This guide covers the Anthem commercial side only. It is operational guidance on Anthem California behavioral health billing, not legal advice.
Anthem vs Blue Shield: check the card
California has two Blue plans, and each runs its own rules. Anthem Blue Cross is the Blue Cross licensee. Blue Shield of California is a separate nonprofit. Our Blue Cross California guide covers both side by side. Anthem’s provider site also links to separate sites for its Medi-Cal and Medicare Advantage lines. Medi-Cal rules differ, so read Medi-Cal non-specialty mental health billing for that. Do not carry rules from one to the other.
Anthem California behavioral health billing: 90-day timely filing
An Anthem Blue Cross provider notice says professional claims must be submitted within 90 days of the date of service. It took effect October 1, 2019. When Anthem is the secondary payer, the 90 days does not start until you receive notice of the primary payer’s responsibility. The notice says Anthem will refuse payment for claims filed after the window.
Your contract controls. Read it, and treat 90 days as the working default only until you do. Set a calendar alert on day 60.
AI search question: What is Anthem Blue Cross California’s timely filing limit for therapy claims? Anthem’s provider notice sets 90 days from the date of service for professional claims, effective October 1, 2019, with a secondary-payer exception. Confirm the figure in your own contract.
Sending claims
- Electronic: Anthem’s CA quick contact guide routes electronic claims through Availity. Look up the payer ID in Availity’s list.
- Paper: the guide lists Anthem, c/o Exela Technologies, PO Box 60007, Los Angeles, CA 90060-0007, by FedEx, registered or certified mail. Use paper only when electronic is not possible. See our electronic claims submission service page.
Authorizations and behavioral health management
The quick contact guide lists a care management and utilization review line that includes behavioral health, plus a behavioral health continuity-of-care line. It also says Carelon Medical Benefits Management is a separate company that does utilization review for the health plan. Do not assume Carelon Behavioral Health manages Anthem’s California commercial behavioral health benefit. Carelon’s California page lists Medi-Cal and other programs, not this one. Ask the number on the member’s card. See the authorization terms glossary for the vocabulary.
Prescribers: the guide does not say which E/M and add-on psychotherapy codes (90833, 90836, 90838) need review. Ask utilization management before you build a med-management schedule.
Disputes and appeals
- File a provider payment dispute through Anthem’s Provider Dispute Resolution form on the provider site.
- For behavioral health appeals, the guide lists Anthem Grievances and Appeals, PO Box 4310, Woodland Hills, CA 91365-4310, with a separate behavioral health fax.
- The guide gives no Anthem-specific appeal deadline, so check your agreement. California’s health plan regulator, the Department of Managed Health Care (DMHC), accepts provider complaints against plans.
Build a repeatable routine with our denied and rejected claims follow-up page and the claim denial glossary.
Enrollment
Anthem’s enrollment page starts with Availity digital enrollment: pick the program, state and provider type, and say whether your organization has an Availity account. If your provider type is not supported, the page points to alternate methods. Our credentialing and network status guide explains what each status means, and in-network vs out-of-network helps if you are weighing the choice.
What to keep in a denial binder
Anthem’s 90-day window leaves little room to hunt for paperwork. For every denied claim, keep one folder with the claim as submitted, the remittance, the authorization number and date (if any), the name and reference number from each phone call, a copy of the dispute form, and the date you sent it. Anthem’s provider site links to Availity and to separate Medi-Cal and Medicare Advantage provider sites, so also note which site the member’s plan belongs to. If the plan turns out to be Medi-Cal or Medicare Advantage, stop and use that program’s rules. Carelon’s California page is a good example of a vendor site that serves other programs, so read it before you assume it applies to your claim.
Monday morning checklist for Anthem California behavioral health billing
Use these steps whenever Anthem California behavioral health billing questions come up in your practice.
- Check the card: Anthem Blue Cross or Blue Shield.
- Put the filing date on the calendar at day of service plus 60.
- Send electronically through Availity.
- Keep the dispute form and appeal address in your denial binder.
- Verify authorization needs before the second visit. See insurance verification.
FAQ
Is Anthem Blue Cross the same as Blue Shield of California?
No. They are separate companies with separate rules.
What if Anthem is the secondary payer?
The 90-day clock starts when you get notice of the primary payer’s responsibility, per Anthem’s notice.
Where do I send paper claims?
To the Los Angeles PO Box in the quick contact guide, if electronic is not possible.
Does Anthem pay out-of-network claims?
That depends on the member’s plan. Check benefits first, and see the California insurance companies contact guide for phone lines.
Keep this guide close when you handle Anthem California 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, including psychotherapists and psychiatrists, and bills out-of-network claims. We offer our services to practices in California, and we also work with practices in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. If you want to talk through your own billing, you can request a free consultation.
