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Click ‘Get Form’ to open the document in the editor.
Begin by entering the Member Name and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for processing.
Fill in the Insurance Identification Number and Member Phone Number. This helps in identifying the member's insurance details.
Provide details for the Ordering Provider, including Name, Specialty, Provider ID Number, Office Address, Phone Number, and Fax Number.
Repeat the process for the Rendering Provider’s information. Make sure all fields are completed accurately.
Enter Facility Name, ID Number, and Address. Specify the Date/Date Range of Service and Service(s) Requested (CPT if known).
Indicate Place of Service (Observation, Outpatient, Inpatient, Other) and provide Diagnosis (ICD-9 if known).
Describe the service being requested using CPT/HCPCS codes and detail the member's condition related to this request.
Complete the attestation section by providing your name and title. Ensure that all required clinical information is submitted at least three business days before the procedure.
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Elevance Health, Inc. is an American for-profit health insurance provider. Prior to June 2022, Elevance Health was named Anthem, Inc.
Can you have Medicare and Anthem at the same time?
If you have both Medicare and Medicaid you can enroll in an Anthem Dual Special Needs Plan, or D-SNP. Its a Medicare Advantage (Part C) plan that supports your whole health, all in one simple plan.
What is the phone number for Anthem MediBlue Medicare Advantage?
Were Ready to Help. Have questions? Talk to a licensed agent: 855-949-3319 (TTY: 711) Monday through Friday, 8 a.m. to 8 p.m.
Are Anthem and Bluecross Blueshield the same?
Anthem is part of the Blue Cross Blue Shield group. Blue Cross Blue Shield is made up of independent companies. Anthem is one of these companies. Other Blue Cross Blue Shield brands include Highmark, Regence and CareFirst.
Are Anthem and Medicare the same?
Medicare Advantage (Part C) plans are offered by private insurance companies like Anthem. They replace your Original Medicare Parts A and B but are required by law to provide all Part A and Part B benefits.
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Anthems Medicare Advantage PPO plans, formerly MediBlue plans, help you save money with no or low plan premiums. Choose an Anthem PPO plan if you want all-in-one coverage that includes Original Medicare (Medicare Parts A and B) and usually Medicare Part D (prescription drug) coverage.
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