Member grievance process and forms must be made available upon request at 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.

We ask that you please review and distribute the Anthem Blue Cross (Anthem) grievance form to all your participating offices.  It’s important to implement a process that will ensure that the attached grievance form is provided to Anthem members upon request.

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, grievance forms, grievance procedures and additional information about Anthem’s expedited grievance and appeals review process, can be found in your Provider Operations Manual. An annual survey will be distributed via Availity to confirm if provider offices have implemented processes to provide grievance forms and assistance to enrollees.

We appreciate your cooperation and support.