Complex Case Management program

Managing illness can be a daunting task for our members. It is not always easy to understand test results, how to obtain essential resources for treatment, or know who to contact with questions and concerns.

Anthem is available to offer assistance in these difficult moments with our Complex Case Management program. Our case managers are part of an interdisciplinary team of clinicians and other resource professionals working to support members, families, PCPs, and caregivers. In addition, the complex case management process uses the experience and expertise of the Complex Case Management team to educate and empower our members by increasing self-management skills. Our complex case managers can help to find services and resources to assist eligible members with chronic conditions that may involve social drivers of health. Our case managers direct members to community resources and make referrals when possible. The complex case management process can help members understand their illnesses and learn about care choices to ensure they have access to quality, efficient healthcare.

Members or caregivers can refer themselves or family members by calling the Member Services number located on the back of their ID card. They will be transferred to a team member based on the immediate need. For example, a member newly diagnosed with diabetes will receive assistance from our diabetic complex case manager, who will help them find diabetic resources available in their community.

Providers can refer their patients by contacting us telephonically or through electronic means. We can help with transitions across levels of care so that patients and caregivers are better prepared and informed about healthcare decisions and goals. Members can opt in and opt out of the case management program at any time.

We’re committed to active involvement with our care provider partners and going beyond the contract to create a real impact on the health of our communities.

You can contact us by email at OHPHcasemanagement@anthem.com or by phone at 844-441-1505 Monday through Friday from 8 a.m. to 5 p.m. ET, except on holidays.