Effective January 1, 2025, Anthem will no longer participate in Kentucky’s Medicaid Managed Care Program. Anthem will continue to be responsible for proper and timely adjudication of all claims for services rendered to its enrollees until 11:59 p.m. on December 31, 2024. Anthem is also responsible for the entirety of all inpatient stays that begin on or before December 31, 2024 and continue past that date until discharge (except for residential substance abuse treatment).
Anthem’s other lines of business — including Commercial, Medicare, Qualified Health Plan, and Kentucky Employees’ Health Plan — are not impacted by this change.
Anthem will continue to accept provider claims for 365 days for services rendered on or before December 31, 2024, and for inpatient hospitalizations that extend beyond the termination date. We urge providers to file claims as quickly as possible to ensure prompt claims adjudication.
Follow the current claims submission process by submitting claims through Availity Essentials or by mail. All claims (including electronic submissions) that do not meet the above criteria will be denied.
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Send all claims submissions to:
Anthem
Kentucky Claims
P.O. Box 61010
Virginia Beach, VA 23466-1010
The claims appeals process will remain the same, and Anthem will accept appeals received no later than 90 days from date of check or denial date. Anthem will respond to appeals within 30 days of receipt. Submit a copy of the denial document and copies of all supporting documents through Availity Essentials or to:
Anthem
Claim Appeals
P.O. Box 62429
Virginia Beach, VA 23466-1599
The Health Care Network team will be available beyond December 31, 2024, to address any concerns or questions. Contact your local provider services at 855-661-2028, Monday to Friday, 7 a.m. to 8 p.m.
Original post here: https://providernews.anthem.com/kentucky/articles/medicaid-contract-expiring-after-december-31-2024-23191
