Anthem HealthKeepers Plus: credentialing for behavioral health providers

Step 1: Virginia Medicaid (DMAS)

Every Cardinal Care plan requires you to be enrolled with Virginia Medicaid first, as a group and as an individual under it. The DMAS PRSS portal also records a participation request for each managed care plan, but that request alone doesn't make you in network. Ours showed Anthem as "No" two months after enrollment. See Virginia Medicaid credentialing.

Step 2: apply through Carelon

1. Update and attest your CAQH profile, with Anthem and Carelon authorized.
2. In Availity, open Payer Spaces > Carelon Behavioral Health, accept Carelon's user agreement the first time, and start a new application in Provider Enrollment: individual, group, or joining a group.
3. Watch email (and spam) for the contract. Carelon sends it for electronic signature; ours went out five days after Carelon received the application.
4. Sign it promptly. Carelon countersigns, then the contract goes to processing and data entry.

Applications filed before Carelon moved to Availity won't appear on the Availity enrollment dashboard. Check those by phone.

What happens after the contract

For a solo psychiatric nurse practitioner practice in the Richmond area, the contract was signed by both sides within three days of being sent. A month later, Carelon was still in data entry. Here's what Carelon told us along the way:

• Credentialing and contracting run in parallel. Credentialing approval comes as a letter to the email on file.
• The effective date and the list of plans the contract covers can't be confirmed until processing is complete. Carelon emails you when it is.
• Your service address has to be linked to the right tax ID. Ask them to confirm both.
• Carelon didn't need a separate Disclosure of Ownership form for our application.
• To add a line of business to an existing Carelon contract later, Carelon uses an amendment request.

Calling Carelon

• Provider services: 1-800-397-1630. Press 4 (all other plans), then 4 (application status).
• Have the provider ID or application ID ready, and write down the call reference number every time.
• Ask four things: status, effective date, which Anthem plans the contract covers (commercial, Medicare Advantage, HealthKeepers Plus), and whether your service address is linked to your tax ID.

Anthem is also the Blue Cross Blue Shield plan for most of Virginia, so the same Carelon contract is how a behavioral health practice reaches Anthem's commercial plans. See the Carelon guide.