Anthem and Blue Cross Blue Shield: Credentialing and Billing for Mental Health Providers

Blue Cross Blue Shield is not one insurer: it is a group of independent companies, each covering certain states. You credential with the Blue plan where you practice, which in Georgia is Anthem Blue Cross and Blue Shield (part of Elevance Health). Patients with Blue plans from other states are usually billed through your local plan under the BlueCard program. Behavioral health for some Anthem plans is managed by Carelon Behavioral Health, so check where each patient’s mental health benefit is managed.

Blue plans together cover a large share of Americans with commercial insurance, so almost every therapy and psychiatry practice sees Blue members. Most Blue-related billing trouble comes from not knowing which Blue company is responsible for what.

How the Blue system works

Term	What it means for you
Local (host) plan	The Blue company for the state where you practice. You credential and contract with this plan. In Georgia, that is Anthem Blue Cross and Blue Shield.
Home plan	The Blue company that issued the patient’s coverage, possibly in another state
BlueCard	The program that lets you bill your local plan for out-of-state Blue members; the local plan routes the claim to the home plan
Member ID prefix	The first characters of the Blue member ID, which identify the home plan
Federal Employee Program (FEP)	Blue coverage for federal employees, with its own rules

Credentialing with Anthem (Georgia and other Anthem states)

1. Prepare the basics: license, individual NPI with correct taxonomy, malpractice coverage, and group NPI if billing as a group.
2. CAQH ProView: complete, attest and share it with Anthem.
3. Request to join the network through Anthem’s provider channels (Anthem uses Availity for many provider transactions). Ask which products the contract covers: commercial, Medicare Advantage, and any Medicaid plans are often separate.
4. Check who manages behavioral health for each product. For some Anthem plans it is managed by Carelon Behavioral Health, which can mean separate steps for mental health providers.
5. Sign the agreement and confirm your effective date, then set up claims, ERA and EFT.

Medicaid plans in Georgia and other states are run by several managed care organizations, each with its own credentialing, even when one of them is Blue-affiliated. See how to get paneled with insurance.

Billing notes for Blue plans

• Out-of-state Blue members: in general, bill your local Blue plan, not the home plan, unless the member’s plan or Blue’s rules say otherwise (for example some FEP or specific account situations).
• Verify benefits for each patient through your local plan, including behavioral health authorization needs.
• Telehealth: follow the local plan’s current telehealth policy for place of service and modifiers; for patients located in another state, licensing and network rules for that state apply (see our telehealth billing guide).
• Document psychotherapy time for every session (see 90837 vs 90834).

Common Blue plan denials

Denial	Usual cause	Fix
Claim sent to the wrong Blue plan	Billed to the patient’s home plan directly	Resubmit through your local plan under BlueCard
Out of network	Credentialed for commercial, patient has a different product, or behavioral benefit managed elsewhere	Check the product and who manages behavioral health
Eligibility	Wrong member ID or prefix	Copy the full ID including the prefix from the card
Authorization required	Higher level of care without approval	Request authorization before the service

See denial codes explained for the codes on the remittance.

We are an independent billing and credentialing company, not affiliated with Anthem, Elevance Health, Carelon or the Blue Cross Blue Shield Association. Payer processes change, so confirm current requirements on your local Blue plan’s provider site. Our mental health credentialing team handles Anthem and other Blue plan applications, and we serve practices in Atlanta and across Georgia.

Frequently asked questions