Nov Industry Notes: Elevance to Penalize Facilities For Out-of-network Providers 

Elevance Health (Anthem) will begin penalizing healthcare facilities in 11 states starting Jan. 1, 2026, for using out-of-network providers for commercial members. Non-compliant facilities face an administrative penalty of 10% of the allowed claim amount and potential network termination. The facility cannot pass this penalty cost to the patient. Emergency care is exempt, but otherwise, all providers must be under contract with Anthem. 

Implications for Urgent Care Centers

For urgent care centers facing high provider turnover and credentialing lags, this policy creates a direct and significant financial risk. 

1. Financial Penalty: If a new provider works before their credentialing is finalized—making them temporarily out-of-network—the urgent care facility will be assessed the 10% administrative penalty on all Anthem commercial claims involving that provider. 
2. Increased Exposure: High turnover means the center is more frequently in the “lag” period with new, uncredentialed staff, dramatically increasing the frequency of penalties. 
3. Risk of Termination: Chronic non-compliance due to persistent credentialing issues could lead to the facility’s eventual termination from the Anthem network. 

The policy essentially mandates that urgent care centers must drastically accelerate their credentialing process to ensure all practicing providers are in-network or risk substantial revenue loss and their contract status.