Maintaining accurate provider information is critically important to ensure our members have timely and accurate access to care.

 

Additionally, Anthem Blue Cross and Blue Shield (Anthem) is required by Centers for Medicare & Medicaid Services (CMS) to include accurate information in provider directories for certain key provider data elements.  For Anthem to remain compliant with federal and state requirements, changes must be communicated 30 days in advance of a change or as soon as possible.

 

Key data elements

 

The data elements required by CMS and crucial for member access to care are: 

  • Physician name
  • Location (such as address, suite if appropriate, city/state, zip code)
  • Phone number
  • Accepting new patient status
  • Hospital affiliations
  • Medical group affiliations

 

Anthem is also encouraged (and in some cases required by regulatory/accrediting entities) to include accurate information for the following provider data elements:

  • Physician gender
  • Languages spoken
  • Office hours
  • Provider specialty/specialties
  • Physical disabilities accommodations
  • Indian Health Service status
  • Licensing information (i.e., medical license number, license state, National Provider Identifier - NPI)
  • Email and website address


How to verify and update your information

To verify information, go to anthem.com and select “Providers,” and then under “Provider Resources” select Find a Doctor tool.  Use “Search as a Guest” at the bottom.  If your information is not correct, please update the information as soon as possible. 

 

Report discrepancies:

 

Please make any necessary corrections using the Provider Maintenance Form. The Provider Maintenance Form (PMF) is available online at anthem.com. Select Providers │ under Provider Resources heading, select Provider Maintenance Form (Note: select Colorado, if you haven’t done so already).  The PMF can also be found on the Availity PortalPayer SpacesAnthem Blue Cross and Blue Shield icon ResourcesProvider Maintenance Form.

 

Access a recorded webinar regarding the Provider Maintenance Form:

 

Note:  If you need assistance with submitting a Provider Maintenance Form, please access our recorded webinar regarding this topic.  Go to anthem.com │ Select Providers │ under Communications heading, select Education and Training │ under Seminars and Webinars heading, select Working with Anthem WebinarsRegister for a Working with Anthem Webinar. 

 

The top portion of the page will show Upcoming Events and the bottom portion will show Event Recordings”.  Use the following access code to view this webinar WwA112019.  (Access code is case sensitive).



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December 2019 Anthem Provider News and Important Updates - Colorado