Quick Tips: adding, changing, terming a provider using the Provider Maintenance Form

Anthem contracted providers are required to update their demographic information when changes occur to their practice / organization, including:

 

• Change of address/location
• Name change
• Tax ID changes
• Provider leaving a group or a single location
• Change in phone/fax numbers
• Closing a practice location
• Change in status for Accepting New Patients
• Plus more

 

As a reminder, our Find Care online tool is used by consumers, members, brokers, and providers to identify in-network physicians and other health care providers supporting member health plans.

 

Action Needed:

To help ensure we have the most current and accurate information, please take a moment to access the Find Care tool and review how you and your practice are being displayed.

• Select Search as a Guest, then Search by All Plans and Networks
• Enter the appropriate search criteria to find your Provider information

 

 

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 be found on the Availity Portal by selecting your state │ Payer Spaces │ Anthem Blue Cross and Blue Shield │Resources │ Provider Maintenance Form.

 

Tips for submitting your updates:

 

• Address changes:

 

• You must select both of the following option to make a complete address change:
  • Address -- Add Location to add a NEW address, and
  • Address -- Terminate to remove an OLD
• Note: Please ensure you are submitting this for all address types; e.g. physical, billing, correspondence addresses, etc.

 

• Termination changes:
  
  
  • Provider Leaving a Group:
    • Use this option to select when it is 1 provider leaving a group.
  • Termination of Provider Participation Agreement:

Use this option when the entire Tax ID is terming

• Roster or List updates:
  
  
  • When making changes for organizations, utilize the Roster or List updates when:
    • your organization is delegated credentialing, or
    • Making 5 or more demographic changes to your organization
  • Note: Access this option by selecting Organization, then select Roster of List Updates
    
    

 

“Working with Anthem” webinar -- August

Don’t forget we are also hosting our “Working with Anthem” webinar and this month’s topic will help Quick Tips for adding, changing, terming a provider using the Provider Maintenance Form. Anthem contracted providers are required to update their demographic information when changes occur to their practice / organization using our online Provider Maintenance Form (PMF).

Learn how to utilize the online PMF to submit changes such as the following:

• Change of address/location
• Name change
• Tax ID changes
• Provider leaving a group or a single location
• Change in phone/fax numbers
• Closing a practice location
• Change in status for Accepting New Patients
• Plus more!

 

Check out our registration link to register today!

 

 

562-0820-PN-CO