Elevance to penalize facilities for out-of-network providers
October 24, 2025
Nona Tepper
Elevance Health has notified healthcare facilities they face penalties for assigning out-of-network clinicians to its members.
Starting Jan. 1, hospitals and other inpatient and outpatient facilities must ensure that all providers involved in care for members of Elevance Health’s Anthem Blue Cross Blue Shield commercial plans in 11 states are under contract with the insurer, Anthem said in a notice.
Facilities that don’t comply may be assessed administrative penalties equivalent to 10% of the allowed amounts payable under the claims in question, and may be terminated from Anthem networks. Facilities are not permitted to pass the cost of administrative penalties on to patients.
To read full article, click here