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.

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 anthem.com/ca/forms. Go to View by Topic and click on the drop-down menu and select Grievance & Appeals, then select the desired resources link.

Also, grievance forms, grievance procedures and additional information about Anthem’s expedited grievance and appeals review process, can be found in your Provider Operations Manual.

Anthem has posted a required learning course via the 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 June 1, 2021. We appreciate your cooperation and support.

To Register for the Course:

1. Log in to Availity Portal at availity.com.
2. At the top of Availity Portal, select Payer Spaces > Anthem Blue Cross.
3. On the payer spaces landing page, choose Access Your Custom Learning Center from the Applications tab.
4. Search for the [Required Grievance Process/Form Course for Anthem Blue Cross Contracted Providers] 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 availity.com to register.
2. Choose 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:

1. Accept privacy and security statements
2. Accept a confidentiality agreement
3. Choose three security questions and answers
4. Create a new password
5. Verify your email address

For questions regarding the Availity Portal, please contact Availity Client Services at 1-800-282-4548.

771-1120-PN-CA