Operational procedures

Operational procedures for guided access HMO are the same as any other local HMO plan. Please use the contact information below.

 

Claims should be filed directly to your local Anthem Blue Cross and Blue Shield (Anthem) office, either electronically or mailed to:

Anthem Blue Cross and Blue Shield

P.O. Box 5747 Denver, CO 80217-5747

 

Online self-service options are available to providers, giving you access to the same information you receive when calling customer service, and provides patient specific information, such as eligibility, benefits, claim status, line-level detail, and payment information. These options include:

  • Availity:* A multi-payer secure provider website available at https://availity.com
  • Electronic data interchange (EDI) available at https://anthem.com/edi
  • Interactive voice response (IVR)/Provider Customer Service available at 877-833-5742

 

Referrals for guided access HMO:

  • Submit a referral via one of the following options:
    • Secure portal: Submit referral request on Availity
    • Public website: Submit the Anthem Referral Form via email
      (CONVUM-Wellpoint@wellpoint.com) or fax (800-763-3142)
    • Phone: 800-336-7767
    • Referrals required for most specialty care
    • The following specialties or services do not require a referral from PCP to an in-network specialist:
      • Addiction medicine
      • Applied behavior analyst
      • Emergent or urgent care
      • Gynecology
      • Licensed professional counselor
      • License clinical social worker
      • Midwife
      • Neonatal/perinatal
      • Obstetrics/gynecology
      • Ophthalmology
      • Optometry
      • Psychiatry
      • Psychology
      • Retail health clinic
  • As long as the provider is in the HMO or Pathway X HMO network, the referral will be approved.
  • Referrals must be completed by the member’s PCP.
  • Referrals to a specialist are required for guided access HMO members.
  • Specialist to specialist referrals do require a referral from the member’s PCP.

 

Submit a referral via Availity:





















Anthem is dedicated to providing excellent customer service for guided access HMO members and their providers. We look forward to building a successful relationship. We appreciate this opportunity to assist you.

 

NVBCBS-CM-004822-22



Featured In:
September 2022 Anthem Provider News - Nevada