Update your provider demographics via the Provider Maintenance Form

Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) professional and professional ancillary providers should now submit changes to their practice profile using our online Provider Maintenance Form.

 

The form is available on both the provider website and the Availity Portal.

 

Online update options include:

• Adding address location.
• Name change.
• Tax ID change.
• Provider leaving a group or a single location.
• Changing phone/fax number.
• Closing a practice location.
• Many more options.

 

Visit the resource page at https://mediproviders.anthem.com/nv to view more change options.

 

The new online form can be found at https://mediproviders.anthem.com/nv > Medical > Provider Forms > Provider Maintenance Form.  The Provider Maintenance Form is also located on the Availity Portal and can be found at https://www.availity.com > Nevada > Payer Spaces > Anthem Blue Cross and Blue Shield Healthcare Solutions > Resources > Provider Maintenance Form.

 

Important information about updating your practice profile:

 

• Change requests should be submitted using the online Provider Maintenance Form link, which will be state-specific.

• Submit the change request online; there is no need to print. Complete and mail, fax or email demographic updates.
• You will receive an autoreply email acknowledging receipt of your request and another email when your submission has been processed.
• For change(s) that require(s) submission of an updated W-9 form or other documentation, attach them to the form online prior to submitting.
• Change requests should be submitted with advance notice.
• Contractual agreement guidelines may supersede the effective date of the request.

 

You can check your directory listing in the Anthem online provider directory. The Anthem provider directory is used by consumers, members, brokers and providers to identify in-network physicians and other health care providers supporting Anthem members. To ensure Anthem has the most current and accurate information, please take a moment to access the online provider directory at https://mediproviders.anthem.com/nv and review how you and your practice are being displayed.

 

ANV-NL-0036-18 August 2018