Anthem has a new nonparticipating provider policy, set to take effect January 1, 2026. The attached article about the new policy shares more details. In summary, participating facilities that continue to use nonparticipating providers who do not have a contract with Anthem and provide services to Anthem members in an inpatient or outpatient facility setting may be subject to corrective measures. These many include: an administrative penalty equal to 10% of the allowed amount of the facility's claims that involve the use of nonparticipating providers; and potential termination from Anthem's networks. Exceptions include emergency services and cases where Anthem has granted prior approval for use of a nonparticipating provider.
A link to Wisconsin's policy (Wisconsin) is attached for more information.
Join this member update to learn more about the policy change, ASCA advocacy efforts and plans to prepare for the policy change.
WISCA Member Update
Friday, December 12 at 12pm
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