12/02/2025

OAASC Works with ASCA on Impending Anthem Policy

As many of you probably know, Anthem has a new nonparticipating provider policy, set to take effect January 1, 2026.  An article about the policy is available here, but in summary, it states that participating facilities that continue to use nonparticipating providers who do not have a contract with Anthem and provide services to Anthem members in an inpatient or outpatient facility setting may be subject to corrective measures. These measures can include: an administrative penalty equal to 10% of the allowed amount of the facility's claims that involve the use of nonparticipating providers; and potential termination from Anthem's networks. Exceptions include emergency services and cases where Anthem has granted prior approval for use of a nonparticipating provider.

While not mentioned in the main policy, links to each of the state policies linked below include an additional exception for instances when no participating care provider is available to render the same services within a geographical area. The policy is proposed to affect Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio and Wisconsin.

OAASC and other state associations have been supporting ASCA in their work to request that Anthem rescind this policy, and we will continue to share information as things develop.