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Skip to footer Login | Members Providers - New York Anthem Resources Resources Overview Provider Manuals, Policies & Guidelines Medical Policies & UM Guidelines Forms Provider Training Academy Pharmacy Information Learn About Availity Referrals HEDIS (The Healthcare Effectiveness Data & Information Set) Vaccination Resources Claims Claims Overview Claims Submissions and Disputes Electronic Data Interchange Prior Authorization Requirements Prior Authorization Lookup Tool Reimbursement Policies Reimbursement Policy Definitions A-Z Reimbursement Policy Disclaimer Patient Care Patient Care Overview Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Behavioral Health Pregnancy & Maternal Child Services Case Management Condition Care Communications Communications Overview Provider News State and National Health Updates Archives Our Network Join Our Network Plan Information Benefits Partners Member Rights & Responsibilities Members Members A A A | Login | Members Attention care providers! Empire BlueCross BlueShield is now Anthem Blue Cross and Blue Shield (Anthem), and Empire BlueCross is now Anthem Blue Cross (Anthem). There is no action needed by our care providers. There will be no changes to your agreements or contract, reimbursement, or level of support — now or in the future — because of our new name. For members, our new name will not cause any reduction to coverage or access to care. For more information, please refer to these Frequently Asked Questions or go to https://providers.anthem.com . You can also contact your Provider Services representative. Launch Availity Prior Authorization Claims & Disputes Forms Provider Training Academy Ensure our members are equipped to renew their Medicaid benefits Help our members prepare to renew their Medicaid healthcare coverage and benefits by educating them on what documents are needed to ensure their renewal form is completed accurately. Members can submit their renewal form via web (preferred), phone, fax, mail, or in person. For questions about eligibility, benefits, authorizations, claims status, and more; log in to Availity Essentials* and select Chat with Payer . For additional support, please use the following resources or contact us if more clarification is needed. Ready, Set, Renew Attention providers! At the end of 2022, Office of the Medicaid Inspector General (OMIG) issued final regulations that repeal and add a new New York Codes, Rules, and Regulations (NYCRR) amendment to implement changes to: Provider compliance programs Medicaid Managed Care plan fraud, waste and abuse (FWA) prevention programs under the Medicaid program The obligation to report, return and explain Medicaid overpayments through OMIG’s Self-Disclosure Program This amendment took effect on December 28, 2022, with enforcement of the requirements beginning March 28, 2023. To participate in and receive payment from the Medicaid program, providers must: Certify to maintaining an effective compliance program that meets the requirements issued by OMIG as part of their annual Certification Statement for Provider Billing Medicaid (ETIN) form Submit a copy of their Certification Statement for Provider Billing Medicaid (ETIN) form to each Managed Care Plan (MMCO) for which they are a participating provider with the MMCO and each year after A copy of your certification/ETIN form may be submitted to our health plan by e-mail to NY_PR_Compliance_Program_Certification@anthem.com . For more detailed information, please visit the Compliance page of the New York State Office of the Medicaid Inspector General Join our network! Interested in joining our provider network? We look forward to working with you to provide quality services to our members. Join our network Vaccine Resources Vaccination is important in fighting against infectious diseases. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and patients against contagious illnesses. Vaccine Resources Availity access The Availity Portal* offers healthcare professionals free access to real-time information and instant responses in a consistent format regardless of the payer. At Availity, you can: Request authorizations. Submit claims. Confirm eligibility. Log in to Availity Learning opportunities Find learning opportunities to assist with administering your patient’s health plan using Availity Essentials multi-payer features and payer spaces applications. Use the library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. Be prepared with the knowledge to assist our members. Launch Provider Learning Hub Don’t have an Availity account? Register free now Receive email from Anthem Anthem is now sending some bulletins, policy change notifications, prior authorization update information, educational opportunities and more to providers via email. Sign up now Provider News Provider News is your source for important news and announcements, including policy updates, prior authorization changes, new product and program offerings, and more. Go to Provider News Featured resources Pharmacy information Search for up-to-date drug information, including hundreds of brand-name and generic medications. Access pharmacy information Maternal child program When it comes to our pregnant members, we are committed to keeping both mom and baby healthy. That’s why we encourage all our moms-to-be to take part in our New Baby, New Life SM program, which is a comprehensive, proactive case management and care coordination program for all expectant mothers and their newborns. Learn about the maternal child program Behavioral health providers We work collaboratively with hospitals, group practices and independent behavioral healthcare providers, community and government agencies, human service districts, and other resources. This enables Anthem to meet the needs of members with mental health and substance use disorders as well as those with intellectual and developmental disabilities. Learn more about behavioral health resources Looking for Medicare, duals or HMO plan information from Anthem? Please visit the Anthem Blue Cross and Blue Shield commercial website for more information. Government resources New York State Department of Health - Medicaid Provider tools & resources Log in to Availity Launch Provider Learning Hub Learn about Availity Prior Authorization Lookup Tool Prior Authorization Requirements Claims Overview Reimbursement Policies Provider Manuals, Policies & Guidelines Referrals Provider Training Academy Forms Pharmacy Information Provider News & Announcements Interested in becoming a provider in the Anthem network? We look forward to working with you to provide quality services to our members. Join our network Anthem Member site Medicare Advantage and Duals Provider Site Contact Us Privacy Policy Terms of Use Waste, Fraud & Abuse © 2023 copyright of Anthem Insurance Companies, Inc. Anthem Blue Cross and Blue Shield is the trade name of HealthPlus, LLC, an independent licensee of the Blue Cross and Blue Shield Association. * Availity, LLC is an independing company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. * CarelonRx, Inc. is and independent company providing pharmacy benefit management services on behalf of the health plan. You’re leaving our site Would you like to continue? Yes, please continue...