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This document serves as a notice for changes related to Anthem Dentacare including updates to employer and employee information, coverage changes, and clinic changes.
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How to fill out Anthem Dentacare Change Notice
01
Locate the Anthem Dentacare Change Notice form.
02
Fill in your personal information accurately, including your name, address, and member ID.
03
Indicate the reason for the change in the designated section.
04
Provide details about your new dental care provider, including name and contact information.
05
Review the form for completeness and accuracy.
06
Sign and date the form to validate it.
07
Submit the form via the recommended method (mail, email, or online portal).
Who needs Anthem Dentacare Change Notice?
01
Current members of Anthem Dentacare who are changing their dental service provider.
02
Individuals who need to update their personal information related to their dental care.
03
Patients seeking continuity of care with a new dentist within the Anthem network.
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People Also Ask about
What is a PMF form for Anthem?
The Provider Maintenance Form (PMF) is used to request changes to existing practice profiles of California physicians, practitioners, professionals and ancillary providers. Change requests should be submitted by the practice manager or a designated person of authority.
How do I contact Blue Cross Blue Shield of California?
For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
How do I contact Anthem CA customer service?
Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.
What is the phone number for Anthem CA customer service?
Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.
Is Anthem of California the same as Anthem Blue Cross?
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
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What is Anthem Dentacare Change Notice?
Anthem Dentacare Change Notice is a notification document used to inform relevant parties about changes to dental care services or provisions under Anthem's Dentacare plan.
Who is required to file Anthem Dentacare Change Notice?
Providers and dental offices that are participating in Anthem's Dentacare program and wish to report changes in their practice or services offered are required to file the Anthem Dentacare Change Notice.
How to fill out Anthem Dentacare Change Notice?
To fill out the Anthem Dentacare Change Notice, enter the required provider information, detail the specific changes being made, and submit the form according to Anthem's guidelines.
What is the purpose of Anthem Dentacare Change Notice?
The purpose of the Anthem Dentacare Change Notice is to ensure communication of changes in dental practices or services, maintaining compliance and clarity between Anthem and its participating providers.
What information must be reported on Anthem Dentacare Change Notice?
The information that must be reported includes provider name, practice address, type of change (e.g., ownership, services offered), effective date of change, and any additional relevant details.
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