New Elevance Health Non-Participating Provider Policy for Anthem Plans

Effective January 1, 2026, Anthem participating facilities that use non-participating (out-of-network) care providers and who provide care to Anthem members in an inpatient or outpatient setting will risk being subject to corrective measures including a 10 percent payment penalty or termination from Anthem’s networks. The new policy will initially affect 11 states: Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, and Wisconsin.

Elevance Health claims the new policy is needed because of the independent dispute resolution process under the No Surprises Act (NSA). Fierce Healthcare reports that Elevance Health claims providers are using the IDR as a “‘back-door payment channel’ for pricey, nonemergent procedures.” The policy, which circumvents the NSA, could lead to further strain on independent practices, and potentially devalue insurance policies purchased by Anthem members that allow them to access out-of-network providers.

CAPITOL ROUNDS DECEMBER 2025