Member grievance and appeals attestation requirement
Anthem Blue Cross’ (Anthem) participating providers are REQUIRED to acknowledge (annually) that Member Grievance and Appeals forms, a description of grievance procedures, and assistance in ﬁling grievances are readily available at each contracted provider location(s).
All pertinent information related to this requirement, including access to forms (in multiple languages) and procedures, is located on Anthem’s website at anthem.com/ca/forms.
- Go to View by Topic and Select the drop-down menu.
- Select Grievance & Appeals.
- Select the desired resource link.
To complete this year’s required attestation, by September 15, 2021, please follow the steps below.
The process takes approximately five (5) minutes.
- Log into Availity: https://www.availity.com/
- Select Payer Spaces> Anthem Blue Cross.
- On the landing page, select Access Your Custom Learning Center from the Applications
- Search (using keyword grievance) for the Member Grievance Form and Attestation
- Enroll and Complete the attestation.
Not yet registered for the Availity Portal?
- Visit https://www.availity.com/
- Select Register.
- Select your organization type.
- In the Registration wizard, follow the prompts to complete registration.
For complete registration instructions Refer to these PDF documents. For any additional questions regarding the Availity Portal, call Client Services toll-free at 1-800-282-4548.
We appreciate your cooperation and support.For additional information regarding member grievance and appeals requirements, please see below.
The Department of Managed Health Care’s (DMHC) routine medical survey includes evaluation of a Health Plan’s compliance with California Health and Safety Code section 1368(a)(2); 28 CCR 1300.68(b)(6) and (7). These regulations require Health Plans to ensure that grievance forms, a description of grievance procedures, and assistance in ﬁling grievances are readily available at each contracting provider’s oﬃce, contracting facility, or Plan facility.
Please review and distribute the Anthem grievance form to all your participating oﬃces. It is important to implement processes to provide grievance forms and assistance to Anthem members promptly upon request.
Your agreement with Anthem requires you to comply with all applicable laws and regulations and to cooperate with Anthem’s administration of its grievance program which includes:
- Annually attesting to Member Grievance and Appeals forms,
- Provide a description of grievance procedures
- Assistance in ﬁling grievances are readily available (at each contracting provider’s oﬃce, contracting facility, or Plan facility)
Information can be accessed on the process of submitting member grievances and appeals, grievance forms in multiple languages, deﬁnitions and appeal rights, on Anthem’s website at anthem.com/ca/forms and within the Anthem Blue Cross Provider Manual.
August 2021 Anthem Blue Cross Provider News - California