Member grievance process and forms must be made available upon request at provider office
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 and grievance forms are provided promptly upon request.
Please review and distribute the Anthem Blue Cross (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.
Information can be accessed on the process of submitting member grievances and appeals, grievance forms, deﬁnitions and appeal rights, on Anthem’s website at www.anthem.com/ca/forms. Go to View by Topic and click on the drop down menu and select Grievance & Appeals, then select the desired resource link.
Also, grievanceforms, grievanceproceduresand additionalinformationabout Anthem’sexpeditedgrievanceandappealsreviewprocess,canbefoundinyourProviderOperationsManual.
Anthem has posted a required learning course via Availity Portal (login required) to ensure all contracted provider oﬃces have implemented processes to provide grievance forms and assistance to enrollees. Please make sure to complete this course and the required attestation by December 13, 2019. We appreciate your cooperation and support.
To Register for the Course:
- Log in to Availity Portal at availity.com.
- At the top of Availity Portal, click Payer Spaces > Anthem Blue Cross.
- On the payer spaces landing page, click Access Your Custom Learning Center from the Applications tab.
- Search for the [Required Grievance Process/Form Course for Anthem Blue Cross Contracted Providers] using keyword grievance.
- Enroll and complete the course, including the required attestation module.
Refer to this guide for more information.
Not registered for the Availity Portal?
Have your organization’s designated administrator register your organization for the Availity Portal.
- Visit availity.com to register.
- Click Register.
- Select your organization type.
- In the Registration wizard, follow the prompts to complete the registration for your organization. Refer to these PDF documents for complete registration instructions.
When you log in to Availity Portal for the first time, Availity prompts you to:
- Accept privacy and security statements
- Accept a confidentiality agreement
- Choose three security questions and answers
- Create a new password
- Verify your email address
For questions regarding the Availity Portal, please contact Availity Client Services at 1-800-282-4548.
December 2019 Anthem Blue Cross Provider News - California