Anthem BlueCross Member Authorization Instructions and Form. Anthem BlueCross Member Authorization Instructions and Form 2026

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4.2 out of 5

23 votes

The document provides detailed instructions for completing the Member Authorization Form, which allows a member to authorize the release of their health information to another person or company. It outlines the necessary personal information required from the member, identifies who can receive this information, specifies what type of information can be released, and explains the purpose and expiration of the authorization. Additionally, it includes provisions for sensitive information and legal representation.

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Click ‘Get Form’ to open the Anthem BlueCross Member Authorization Instructions and Form in the editor.
In Part A, provide your member information. Fill in your last name, first name, middle initial, date of birth (mm/dd/yyyy), full address, daytime phone number, identification number, and group number as found on your member ID card.
Move to Part B to specify the person or company receiving your information. Check the appropriate box and enter their full name. Avoid general terms like 'my daughter' or 'my son'.
In Part C, indicate what information can be released. Choose between all information or limited information by checking the relevant boxes.
Part D requires you to state the purpose of this approval. Check the box that applies to your situation.
In Part E, select when you want this approval to expire—either one year from signing or an earlier specified date.
Finally, sign and date in Part F. Ensure your signature matches the name provided in Part A.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is Anthem Blue Cross the same as regular Blue Cross?

Anthem and Blue Cross Blue Shield are related, but they are not the same company. While they are both top health insurance providers in the USA, the big difference is that Blue Cross Blue Shield is the umbrella that is made up of several independent companies, and one of these smaller companies is Anthem.

How do I get my Anthem prescription card?

You can request a new Anthem ID card by calling 800-676-BLUE (2583) or print a new card online.

What is the fax number for Anthem BCBS Virginia prior authorization?

Fax: 1-800-964-3627.

Is Anthem Blue Cross Blue Shield the same as Blue Cross Blue Shield Reddit?

Anthem is a brand under the parent company Elevance Health. Elevance Health operates Blue Cross and Blue Shield plans / licenses all around the country.

Does Anthem require prior authorization for Ozempic?

Prior authorization from Anthem is necessary for initial coverage of Ozempic.

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Are Anthem Blue Cross and Blue Cross the same?

Medi-Cal Managed Care (Medi-Cal) Anthem Blue Cross is the trade name of Blue Cross of California.

Is Anthem accepted in all the states?

We serve our members as the Blue Cross licensee for California and as the Blue Cross and Blue Shield, or BCBS, licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (in the New York City metropolitan area and