Member grievance process and forms must be made available upon request at behavioral health provider offices

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 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, and then select the desired resource link.

 

In addition, grievance forms, grievance procedures, Anthem’s expedited grievance and appeals review process, can be found in the Anthem Blue Cross Facility and Professional Provider Manual

 

Anthem has posted a required learning course via Availity Portal (login required) to ensure 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 June 1, 2020: 

1. Log in to Availity Portal at com.
2. At the top of Availity Portal, click Payer Spaces > Anthem Blue Cross.
3. On the payer spaces landing page, click Access Your Custom Learning Center from the Applications
4. Search for the Member Grievance Form and Attestation - Online Course using keyword grievance.
5. 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.

 

1. Visit com to register.
2. Click Register.
3. Select your organization type.
4. In the Registration wizard, follow the prompts to complete the registration for your organization. Refer to these PDF documents for complete registration instructions.

Getting Started

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, call Availity Client Services toll-free at 1-800-282-4548.

 

We appreciate your cooperation and support.