Provider Enrollment Application - Secure.in.gov
Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care ConnectProvider EnrollmentApplicationA new, quick, and intuitive way toenroll and become a participatingprovider with Anthem Blue Cross andBlue Shield (Anthem)
Agenda AcronymsWhat the Provider Enrollment Application isHow to access the applicationEnrollment dashboardEnrollment processContact information2
Acronyms CAQH — Council for Affordable Quality HealthcareDPE — Digital provider enrollmentPE — Provider ExperiencePMP – Primary medical provider3
Submit an enrollment application onlineDigital provider enrollment is a way to enroll to become a participatingprovider with Anthem to serve Medicaid and Medicare Advantage members.The tool is hosted in Availity and uses CAQH ProView to extract data fromthe provider’s CAQH profile.Who can use this tool?Professional providers whose organizations do not have a credentiallingdelegation agreement with Anthem.4
Submit an enrollment application onlineHow can this new tool be used? Add new providers to an already existing group. Apply and request a contract. Enroll a group of new providers. Use a dashboard for real time status on the submitted applications. Create streamlined complete data submission.Note: For any changes to your practice profile and demographics, continueto use the online Provider Maintenance Form.Currently, ancillary and facility providers are the only excluded providertypes. These providers should continue to use the current enrollmentprocess.5
General rules for submitting an applicationIf the provider has a CAQH profile (PMPs and specialists): Ensure the CAQH ProView profile is in Initial Profile Complete orRe-Attestation status. Ensure the CAQH ProView profile is attested, and Anthem is authorizedto access it.The CAQH ProView profile data must be correct and complete with allspecialty information saved into the profile. A primary specialty ismandatory. The primary specialty is the specialty, which will be listed in thedirectory.New profiles will remain in Profile Data Submitted status until CAQH hasapproved the profile.6
General rules for submitting an application(cont.)For help, visit: CAQH ProView for Providers and Practice Managers.The organization must be registered with Availity* and have an Availity loginID under the organization. The Availity user ID should be assigned the role ofProvider Enrollment.7
Before you get started1. Register your organization on https://www.availity.com: Create your personal user account under yourorganization within Availity:o Under More, select Add User or Maintain User.o Assign the user the role of Provider Enrollment.2. Update your CAQH profile and complete the following: Review and attest your CAQH profile. Ensure Anthem is authorized to view your CAQHdata. Select a primary specialty.3. Start your Provider Enrollment application process: Under Payer Spaces, select the Anthem logo, thenselect Applications and Provider Enrollment.8
Where is the application located?Follow the steps below to access the enrollment application:Navigate to https://providers.anthem.com/in. Select Join our network.9
Where is the application located?Select Jointhe AnthemNetwork.10
Where is the application located? (cont.) If the answer to the Availity question is no, create an Availity account.11
Where is the application located? (cont.) If the answer to the Availity question is yes, log into your Availity account.12
Where is the application located? (cont.) Select Payer Spaces.13
Where is the application located? (cont.) Select the Anthem logo.14
Where is the application located? (cont.) Select Applications, then Provider Enrollment.15
Select Applications, then Provider Enrollment.My Dashboard is the place to track yoursubmission.Select Begin new applicationto start the enrollmentprocess.The left-handnavigationoptions allowproviders tofind theirapplicationsand checktheir status.Real time status updates of your applications.16
Begin the enrollment processSelect the organization name.Select the tax ID.Select the provider type. This will directthe provider to the correct enrollmentexperience.Ancillary providers will bedirected to the provider websitefor instructions.17
What would you like to do?Select to add providers to an existing group.Select to create a new provider group and receivea contract.18
Step 1: Getting started – group informationProvide groupinformation when youare adding a providerto an existing groupor enrolling a newprovider group.19
Step 1: Getting started – provider informationSelect the number of providersto enroll.Select Find Provider — Thispulls data from CAQH.Enter the CAQH andNPI number for theprovider.Providers must have anattested CAQH profile andhave authorized Anthem toaccess their data.20
Step 1: Getting started – CAQH informationThe application pulls data fromthe provider’s CAQH profile: Review the information foreach provider. Complete any missing data.The red bar indicates arequired field.21
Step 1: Getting started – address informationThis step captures allthe addressinformation andcontacts.We are collecting the: Primary practiceaddress. Billing/remittanceaddress andcontact. Office managercontact.Choose anaddress/contact oradd a new one (ifneeded).22
Step 1: Getting started – network selectionsProviders who needcontracts may beprompted to selectthe provider networksin which they willparticipate.The networkselections will reflectthe products availablein the state to whichthey are applying.23
Step 1: Getting started – review all informationReview the data and selectany of the Edit buttons toedit the data.24
Step 2: Additional information – documentsrequired In step two,documents andadditional informationare collected.The application willautomatically pullrequired documentsfrom CAQH ifavailable.Documents arecollected at theprovider and grouplevel.Drag and drop files oruse the upload featureto add documents tothe application.25
Step 2: Additional information – hospitalaffiliationsReview eachprovider’s hospitalaffiliationinformation andprovide anymissinginformation.26
Step 2: Additional information – service locationsThere are three stepswithin ServiceLocations: Select the actualaddresses whereproviders practice. Reviewinformation foreach location toensure theaccuracy of data. Assign providersto those servicelocations.27
Step 2: Additional information – contract signerSupply the name andinformation of theperson authorized tosign the contractwhen enrolling a newsolo provider orprovider group.Choose the addressfor the signatory orenter a new one.28
Step 3: CompletionThis is the final stepof the applicationprocess: Each provider willhave anapplication ID. The applicationID allows theprovider to viewthe status ofeach individualapplication.Application IDPR-10375To check the status of your application:Select the Go to dashboard button to go back to thedashboard and view the application status. You willneed the application ID to check your status.29
Checking provider enrollment statusfrom My Dashboard30
Before you are ready to see Anthem members1. You must complete the Provider Enrollment Application.2. You must pass credentialing, if applicable, to your specialty type:o Refer to the Credentialing Program Summary Guide for providers thatrequire credentialing.oro Go to https://providers.anthem.com/in Resources Providermanuals and guides Credentialing Program Summary Guide.and3. You must have a fully executed contract:o The contract is not valid until signed by the provider and Anthem, andthe provider has met credentialing requirements.o You will receive a Welcome Letter that includes your contract effectivedate, and this is when you may start seeing members and submittingclaims.31
Troubleshooting tipsWhen working on the application, you may run into technical issues or questions.These quick tips will help you navigate this new platform by addressing some of thecommonly asked questions: If you see an error messages when adding provider information, ensure:o A primary specialty has been selected in CAQH ProView.o The provider’s CAQH ProView profile has been attested.o The provider’s CAQH ProView profile has designated Anthem as anauthorized user.o The provider’s CAQH profile is in an Initial Profile Complete status. If theprofile is new, CAQH reviews the profile before moving it to Initial ProfileComplete status.o All documentation has been uploaded to CAQH.If the system is down, you will receive a System Not Available message. Yourapplication will be saved, but you will need to finish at a later time. If you experienceissues with Availity organization registration, call Availity support at 800-282-4548(800-AVAILITY) or visit the Contact Us page on Availity.32
Troubleshooting tips (cont.)For CAQH issues: If you see error messages after you select Find Provider, check if there is aprimary specialty chosen in CAQH or if the primary specialty information isincomplete:o The CAQH profile must be in either Initial Profile Complete orRe-Attestation status.o Profile Data Submitted status is shown when a new profile has been createdand submitted to CAQH, but the profile has not been approved by CAQH.33
QuestionsFor eligibility and benefits questions: Check eligibility and benefits online through Availity Chat — via Availity Payer Spaces Applications Chat with Payer Call Provider Customer Service at:o Hoosier Healthwise: 866-408-6132o Hoosier Care Connect: 844-284-1798o Healthy Indiana Plan (HIP): 844-533-1995For claims questions: Check claim status online through Availity Chat — via Availity Payer Spaces Applications Chat with Payer Call Provider Call Provider Customer Service at:o Hoosier Healthwise: 866-408-6132o Hoosier Care Connect: 844-284-1798o HIP: 844-533-199534
Providerexperiencephysical healthzone maphttps://providers.anthem.com/docs/gpp/IN CAID PU NetworkRelationsMap.pdf?v 202110061311Dir, Provider ExperienceJacquie MarsalisJacqueline.Marsalis@anthem.com35
ProviderExperiencebehavioralhealth subjectmatter experts36
Questions?Thank you for your participation in serving our members enrolled in HoosierHealthwise, HIP, and Hoosier Care Connect!37
Serving Hoosier Healthwise, Healthy Indiana Planand Hoosier Care Connect* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.https://providers.anthem.com/inAnthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross andBlue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connectthrough an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelinesand practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions,please contact your group administrator or your Anthem network representative.INBCBS-CD-006965-22 September 2022
provider with Anthem Blue Cross and Blue Shield (Anthem) Provider Enrollment Application. Agenda 2 Acronyms What the Provider Enrollment Application is How to access the application Enrollment dashboard Enrollment process Contact information. Acronyms 3
If you have questions about completing the provider enrollment forms, please call the Medicaid fiscal agent's Provider Enrollment Unit at 1-800-377-8216. Additional Forms - All of the forms that you need related to provider enrollment or changes in enrollment information are available on the Medicaid fiscal agent's Internet site at
Online Provider Enrollment User Manual, Chapter 2 1 Updated 08/15/2022 (pv06/04/2021) Chapter 2. Initial Enrollment Application To begin the Online Provider Enrollment Application: 1. On the Nevada Medicaid and Nevada Check Up Health Care content site home page, www.medicaid.nv.gov, click the "Provider" tab, and select "Provider .
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Provider Enrollment Unit will contact you by telephone, email, fax, or mail. This contact is intended to. . days plus mailing time before inquiring about the status of your application. IHCP Provider Enrollment Unit P.O. Box 7263 Indianapolis, IN 46207-7263 3 of 32 IHCP School Corporation Provider Enrollment
New Enrollment Providers: Providers who are completing a new Family Practice, General Internal Medicine, or Pediatric provider enrollment application via the online Provider Enrollment Web Application will be prompted to complete the attestation form when completing the Provider Type and Specialty/Subspecialty page of the application.
IHCP Family Member/Associate Transportation Provider Enrollment and Profile Maintenance Packet. in.gov/medicaid/providers . IHCP Provider Enrollment Unit P.O. Box 7263 Indianapolis, IN 46207-7263 3 of 11 IHCP Family Member/Associate Transportation Provider Enrollment and Profile Maintenance Packet Version 1.1, March 15, 2021
Idaho MMIS New Provider Enrollment User Guide -Individual Last Updated: 05/17/2022 Page 5 of 40 4. User Interface and Navigation 4.1. My Enrollment Application Home Page To access the provider enrollment application, a user must sign into the Idaho Gainwell Technologies Medicaid website at www.idmedicaid.com. Once signed in, hover over the
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