Anthem Provider Maintenance Form 2010 free printable template
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Section F. ADDITIONAL OFFICE LOCATION(S) Practice Name Add Delete Email Address Second Practice Address Billing Address (if applicable, note same as .........') Billing Email Address Correspondence
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How to fill out Anthem Provider Maintenance Form
01
Obtain the Anthem Provider Maintenance Form from the Anthem website or your provider network.
02
Fill in the provider's identification information, including NPI number and tax ID.
03
Provide accurate contact information, including phone number and email address.
04
Indicate the reason for the maintenance request (e.g., change of address, updating credentials).
05
Include any additional documentation required to support your request, such as copies of new certifications or licenses.
06
Review the completed form for accuracy and completeness.
07
Submit the form according to the instructions provided (online submission, fax, or mail).
Who needs Anthem Provider Maintenance Form?
01
Healthcare providers who need to update their information with Anthem.
02
Providers who have had changes in their practice location, contact details, or credentials.
03
New providers who are joining the Anthem network and need to establish their information.
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People Also Ask about
Is Anthem Blue Cross Blue Shield Ohio an HMO or PPO?
Anthem Blue Cross is an HMO plan with a Medicare contract. Enrollment in Anthem Blue Cross depends on contract renewal.
Is Anthem the same as Blue Cross Ohio?
About Anthem Blue Cross and Blue Shield in Ohio ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
What is a PMF form at Anthem?
Provider Maintenance Form. The Provider Maintenance Form (PMF) is to be used by California physicians, practitioners, professionals and ancillary providers to request changes to their practice profiles with Anthem BlueCross.
What is the provider number for Anthem Blue Cross Blue Shield of Ohio?
By Phone: Call the number on the back of the member's ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative.
What is a PMF form for Anthem?
Provider Maintenance Form. The Provider Maintenance Form (PMF) is to be used by California physicians, practitioners, professionals and ancillary providers to request changes to their practice profiles with Anthem BlueCross.
What does PMF mean in insurance?
As a Presidential Management Fellow (PMF), you will be eligible for the same benefits as most Federal employees. These benefits may also include spouses and family members. Benefits may consist of the following: A wide variety of insurance plans at government rates, Such as: Health.
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What is Anthem Provider Maintenance Form?
The Anthem Provider Maintenance Form is a document used by healthcare providers to update their information and maintain accurate records within the Anthem network.
Who is required to file Anthem Provider Maintenance Form?
All healthcare providers who are part of the Anthem network or those seeking to update their information are required to file the Anthem Provider Maintenance Form.
How to fill out Anthem Provider Maintenance Form?
To fill out the Anthem Provider Maintenance Form, gather the necessary information, complete each section accurately, and submit the form according to the instructions provided by Anthem.
What is the purpose of Anthem Provider Maintenance Form?
The purpose of the Anthem Provider Maintenance Form is to ensure that the provider's information is current and accurate, facilitating efficient communication and service delivery within the Anthem network.
What information must be reported on Anthem Provider Maintenance Form?
Information that must be reported includes the provider's name, contact details, practice location, specialties, billing information, and any changes to this information.
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