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Anthem bcbs referral form

Anthem cross referral form 2026

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The document is a Case Management Referral Form for L.A. Care's Medi-Cal Managed Care program, detailing the process for referring patients to Anthem Blue Cross for case management services. It includes sections for patient information, eligibility verification, referral source details, and specific programs available such as Complex Case Management and High-Risk Obstetrics. The form outlines the necessary steps and contact methods for submitting referrals and receiving notifications about referral outcomes.

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Click ‘Get Form’ to open the anthem cross referral form in the editor.
Begin by entering the 'Referral Date' at the top of the form. This is essential for tracking the referral process.
In the 'Eligibility' section, indicate whether eligibility has been verified by selecting 'Yes' or 'No'.
Fill out the 'Referral Source Information' with your name and phone number. Ensure you inform the member or caregiver about this referral.
Attach any necessary records by checking 'Records attached?' and provide details about the referring entity.
Complete the 'Member Information' section, including their name, ID, date of birth, and primary language.
Select relevant admission history and primary diagnoses that apply to the member from the provided options.
Choose applicable programs for referral from the list provided, ensuring you understand each program's purpose.
Finally, specify your reason for referral in detail before submitting it via fax as indicated on the form.

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2019	4.8 Satisfied (40 Votes)

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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.

Do I need a referral for physical therapy Anthem?

You do not need a prescription to start physical therapy. As an Anthem Blue Cross patient, you can see a therapist without a referral.

How do I contact Anthem NY customer service?

Telephone: Call BlueCard Eligibility at 800-676-BLUE (2583).

What is the phone number for Anthem BCBS NY provider relations?

Non-participating providers: Call the number on the back of the members ID card or call 800-676-BLUE (2583) to docHub Provider Services. You can also use chat or secure messaging directly in Availity.

Is Anthem the same as Blue Cross Blue Shield?

Is Anthem the same as Blue Cross Blue Shield? 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.

How do I contact Anthem Blue Cross of California?

1-855-817-5785 (TTY: 711) Monday through Friday from 8 a.m. to 8 p.m. The call is free.

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What is the phone number for Anthem Blue Cross provider relations?

You can also call a representative at 800-300-8181 (TTY 711), Monday through Friday from 8 a.m. to 8 p.m. and on Saturday from 9 a.m. to 5 p.m. Eastern time.