Maintaining accurate provider information is critically important to ensure that our members have timely access to care. Updated information helps us maintain accurate provider directories and also ensures that providers are more easily accessible to members. Additionally, Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc. are required by Centers for Medicare & Medicaid Services (CMS) to include accurate information in provider directories for certain key provider data elements.  CMS routinely reviews/audits our provider directories for accuracy and completeness.

 

Since it is the responsibility of each provider to inform insurance health plans when there are changes, providers are reminded to notify Anthem of any changes to their demographic information or other key pieces of information, such as a change in their ability to accept new patients, street address, phone number or any other change that affects patient access to care. For Anthem to remain compliant with federal and state requirements, changes must be communicated within 30 days in advance of a change or as soon as possible so that members have access to the most current information in our provider directory.


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 certain regulatory/accrediting entities) to include accurate information for the following provider data elements:

 

  • Physician Gender
  • Languages Spoken
  • Office Hours
  • Specialties
  • Physical Disabilities Accommodations (e.g., wide entry, wheelchair access, accessible exam rooms and tables, lifts, scales, bathrooms and stalls, grab bars, other accessible equipment)
  • Indian Health Service Status
  • Licensing information (i.e., Medical License Number, License State, National Provider Identifier NPI)
  • Provider Credentials (i.e., Board Certification, Place of Residency, Internship, Medical School, Year of Graduation)
  • Email and website address
  • Hospital has an emergency department, if applicable

How to update your information

You should routinely check your current practice information by going to anthem.com and access our “Find a Doctor” tool. If your information is not correct and updates are needed, please provide the correct information as soon as possible by visiting anthem.com.  Select “Provider,” and then under “Provider Resources” select the "Provider Maintenance Form" and complete the online prompts. Please verify before proceeding that “Information for Virginia” is displayed.  Either choose “Select a State” or “Change State” if necessary.  If you have questions about using the Provider Maintenance Form, check out the “Provider Maintenance Form Guide” for more information.


If you have questions about updating your demographic information, contact your Anthem network manager.

Provider Maintenance Form

 



Featured In:
May 2019 Anthem Provider Newsletter - Virginia