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Get Transitional Care Form Anthem
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How to fill out the Transitional Care Form Anthem online
Filling out the Transitional Care Form Anthem is an essential step for new members transitioning from another health plan to ensure continuity of care. This guide provides a comprehensive overview of how to complete the form online effectively.
Follow the steps to complete the Transitional Care Form Anthem online.
- Click ‘Get Form’ button to obtain the form and open it for editing.
- Start by entering the subscriber/employer information. Provide the subscriber's name, coverage effective date, group number, employer name, and type of coverage (e.g., HMO, PPO).
- Fill in the patient information section. Include the patient’s name, date of birth, patient ID number, home and work telephone numbers, address, and the best time to contact them.
- Provide details about the primary care provider (PCP). Enter the PCP’s name, address, and telephone number.
- Complete the specialist information. List up to two specialists by entering their names, addresses, and telephone numbers.
- Indicate the services requested for transitional care by checking the appropriate boxes. Options include ambulatory/same day surgery, durable medical equipment, inpatient care, hospice care, and more. Provide a brief description of any chronic or long-term illness and diagnosis details.
- Answer the questions regarding the involvement of a nurse case manager and whether you would like to be contacted by the Case Management Department at Anthem. Indicate your answers with 'Yes' or 'No' and provide any necessary details.
- Obtain the signature of the subscriber, guardian, or parent of the patient, followed by the date of completion.
- Once you have filled out all required fields, save your changes. You can then download, print, or share the form as needed.
Complete the Transitional Care Form Anthem online today to ensure a smooth transition in your care.
Getting reimbursed by Anthem involves filing a claim for the expenses you incurred. Start with the Transitional Care Form Anthem, ensuring all details are filled out comprehensively. Submit this form along with your receipts to Anthem through their recommended channels. Stay in contact with their support team for updates, ensuring you receive your reimbursement as quickly as possible.
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