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How to use or fill out PROVIDER MAINTENANCE FORM - Anthem Health Insurance with our platform
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Click ‘Get Form’ to open the PROVIDER MAINTENANCE FORM in the editor.
Begin with SECTION A: GENERAL INFORMATION. Fill in your Primary Care Provider or Specialist details, including your name, group practice name, and Tax ID. Ensure all fields are completed clearly.
Move to SECTION B: REASON FOR SUBMITTING FORM. Indicate the effective date and check the appropriate box for your request (add, change, cancellation). Provide a brief description of the reason for submitting this form.
In SECTION C: PROVIDER INFORMATION, enter your full name, SSN, specialty, and acceptance status for new members. If applicable, include previous names for changes.
Complete SECTION D: ADDRESS with both practice and billing addresses. If you are changing an address, ensure to fill out SECTION E as well.
If adding or deleting office locations, fill out SECTION F accordingly. Include any new Tax ID numbers if necessary.
In SECTION G: COVERING PHYSICIANS, indicate whether you are adding or deleting covering physicians by providing their names and degrees.
Finally, complete SECTION H: CONTACT SIGNATURE by entering your contact information and signing the form before submission.
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Is Anthem Blue Cross the same as Anthem Blue Cross?
Get To Know Anthem Anthem Blue Cross is the trade name of In California: Blue Cross of California, Anthem Blue Cross Partnership Plan, Anthem BC Health Insurance Company and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.
What is the phone number for Anthem provider services?
Providers contact on members behalf: (800) 677- 6669 Interpretation: Instruct members to contact number on back of ID card. Providers: (800) 677-6669, request to speak to an interpreter.
What is the phone number for Blue Cross Blue Shield of California provider?
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.
What is the phone number for Anthem provider maintenance?
Non-participating providers: Call the number on the back of the members ID card or call 800-676-BLUE (2583) to reach Provider Services. You can also use chat or secure messaging directly in Availity.
Is Anthem the same as Anthem Blue Cross?
Filing your claims should be simple. Thats why Anthem uses Availity, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to healthcare professionals. You can use Availity to submit and check the status of all your claims and much more.
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Each practitioner or HDO must complete a standard application form when applying for initial participation in one or more of Anthem networks or plan programs.
SpecialOffers@Anthem Fitness Reimbursement Program
This form will be returned if: 1) The form is not completed with the required information and 2) an original receipt and completed log card or fitness center
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