Providers - New York Anthem

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.

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.

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.

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.

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.

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.

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.

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.

Featured resources

Pharmacy information

Search for up-to-date drug information, including hundreds of brand-name and generic medications.

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 LifeSM program, which is a comprehensive, proactive case management and care coordination program for all expectant mothers and their newborns.

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.

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

Interested in becoming a provider in the Anthem network?

We look forward to working with you to provide quality services to our members.