Anthem Mental Health Billing: 5 Easy, Essential Checks
Anthem mental health billing is the work of getting behavioral health claims paid by Anthem, a Blue Cross Blue Shield brand of Elevance Health. Elevance holds the Blue Cross and Blue Shield license in 14 states, including Georgia, Connecticut and New York. The name on the card is Anthem, but another company may credential you or approve care, so check before you bill.
Anthem mental health billing starts with the right payer
Anthem is one Blue Cross Blue Shield licensee, not all of them. Blue Cross NC and the other independent Blue plans run their own rules, so never carry an Anthem rule over to another Blue plan. Inside Anthem, Carelon Behavioral Health manages the behavioral health network in several states. Its provider guides for Maine and Virginia, both dated February 7, 2023, send credentialing questions to the Carelon National Provider Service Line, and send claims through Availity, the free clearinghouse portal most Blue plans use.
| State | What the sources confirm | What you confirm yourself |
|---|---|---|
| Georgia | Elevance is the Blue licensee. Carelon’s Georgia page lists the Georgia Collaborative ASO, a state program, and no Anthem commercial guide. | Whether your Anthem commercial members’ mental health benefits sit with Anthem or a vendor. |
| Connecticut | Carelon’s Connecticut guide (February 7, 2023) covers Anthem commercial and Medicare Advantage plans. Claims go through Availity. | Who credentials you for each plan type. |
| New York | Anthem announced that Empire Blue Cross Blue Shield would be renamed Anthem on January 1, 2024, pending state approval. | Which name is on the member’s card, and who handles mental health. |
Our own Blue Cross guides cover Georgia, Connecticut and New York.
How do I bill Anthem for mental health claims?
Run an eligibility check in Availity and note which company manages mental health benefits. Send the claim the way that check says, through Availity or your clearinghouse. Keep the authorization number, the call reference number and the date for every step, because Anthem mental health billing problems usually trace back to one missing detail.
Where Anthem mental health billing usually breaks
Four things cause most of the trouble. The claim goes to the wrong company because the card says Anthem and a vendor holds the benefit. The credentialing record names an old tax ID or address. The authorization was verbal and nobody wrote the number down. Or the claim missed the filing window in the contract. Each one is a front-desk habit you can fix, and each is cheaper to fix before the claim leaves than after the denial arrives.
Keep a simple log for Anthem mental health billing: patient, plan, date checked, who manages mental health, authorization number, and where the claim was sent. Ten minutes a day on that log saves hours of rework.
Private payers
For commercial Anthem plans, your contract and Anthem’s provider manual for your state set the filing window, the appeal deadline and the claim edits. Read them once and write the numbers on a one-page cheat sheet for the front desk. If you are out of network, the rules change again, so see our guide to in-network and out-of-network credentialing.
Psychiatrists should ask one extra question. Do evaluation and management (E/M) visits go to the same administrator as psychotherapy visits? Do not assume they do.
Medicare and Medicaid
Connecticut’s Carelon guide also covers Anthem Medicare Advantage plans. In New York, Carelon’s guide for Medicaid from Empire BlueCross HealthPlus (January 2023) lists payer ID 26375 and a 90-day filing limit from the date of service, or the timeframe in your agreement. That document is old, so confirm both before you rely on them. Georgia Medicaid is outside this post.
State rules
Georgia has prompt-pay statutes, O.C.G.A. 33-24-59.5 and 33-24-59.14, which the state insurance office cites. Connecticut and New York have their own rules, so ask each state’s insurance regulator. Do not apply Georgia’s rule in Connecticut.
Denials, appeals and your insurance contacts
When an Anthem claim is denied, read the remittance codes first. Our guide to CARC and RARC codes shows how. Then compare the denial to your contract and file the appeal inside the window printed on the letter. Our insurance companies contact directory helps you find the right department.
| Check | Question to answer |
|---|---|
| Payer | Anthem, Carelon or another vendor for mental health? |
| Credentialing | Which company holds your contract and your effective date? |
| Claims | Availity, clearinghouse or paper, and which payer routing? |
| Authorization | Is it needed, and where is the number on file? |
| Deadlines | Filing window and appeal window from your contract? |
What to do Monday morning
- List your Anthem patients by state and plan type.
- Run an Availity eligibility check for each and record who manages mental health.
- Pull your Anthem contract and write down the filing and appeal windows.
- Check that your credentialing record matches the company that pays you.
- Review last month’s denials and look for patterns in your Anthem mental health billing.
The short version: Anthem mental health billing
Anthem mental health billing works when you confirm the payer, the vendor, the filing window and your credentialing record before the claim goes out. Georgia, Connecticut and New York each need their own check. Keep a call reference number for every step.
How MCM South helps
MCM South Medical Billing Service, LLC bills exclusively for mental and behavioral health. We work with psychotherapists and psychiatrists in solo and medium-size practices, and we bill out-of-network claims for clients. If denials are eating your week, see how we handle denied and rejected claims.
Keep going
Related reading
Want help with payer follow-up? Talk to us.
FAQ
Is Anthem the same as every Blue Cross Blue Shield plan?
No. Anthem is one licensee of the Blue Cross Blue Shield Association. Elevance Health holds the license in 14 states, and other Blue plans, such as Blue Cross NC, are independent. Check each plan on its own.
Does Carelon handle all Anthem mental health claims?
Not everywhere. Carelon publishes provider guides for Anthem plans in several states, but its Georgia page lists only a state program. Confirm in your eligibility check who manages mental health for each member.
Where do I send Anthem mental health claims?
Most Anthem plans accept claims through Availity or your clearinghouse. Carelon’s Connecticut, Maine and Virginia guides say so. Use the routing your eligibility check returns.
Do the rules in Georgia apply in Connecticut?
No. Each state sets its own insurance rules, and each Anthem contract sets its own deadlines. Read the contract for the state you bill in.
Where MCM South works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
