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Get Continuity Of Care Form - Anthem
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How to fill out the Continuity Of Care Form - Anthem online
Completing the Continuity Of Care Form - Anthem is an essential process for ensuring that your health care remains uninterrupted during transitions in your insurance or provider network. This guide provides step-by-step instructions to help users navigate the form online with ease.
Follow the steps to successfully complete the form online.
- Press the ‘Get Form’ button to access the Continuity Of Care Form - Anthem and open it in the online editor.
- Begin by providing general information about yourself. Fill in the subscriber’s name, Anthem Blue Cross ID number, employer name, and the date you became active with Anthem Blue Cross.
- Next, include the patient’s name, their relationship to the subscriber, date of birth, and any allergies.
- Indicate your preferred phone number and secondary contact number. Specify if it is a home, work, or cell number.
- State the name of the terminating insurance plan, and circle the type of that plan. Then, specify your new Anthem Blue Cross plan type.
- Answer whether you are a new enrollee to Anthem Blue Cross. Provide the names of the PMG/IPA associated with both the terminating plan and the new Anthem Blue Cross plan.
- If applicable, detail the diagnosis, including relevant medical history. If you have upcoming appointments with specialists, provide their names, types, phone numbers, appointment dates, and reasons for visits.
- Indicate if you are currently receiving any ongoing services. List the services along with the associated medical or behavioral health providers.
- Provide information about any scheduled hospitalizations, surgeries, or procedures, including dates and the names of the physicians performing them.
- Disclose if you have been admitted to the hospital or visited the emergency room in the past six months, including the reason and dates of services.
- Complete any other needs section with relevant information.
- Finally, sign the authorization section, giving permission for the provider to share necessary medical records with Anthem Blue Cross, and specify the preferred contact method for confidential information.
- After completing all fields, save your changes and prepare to download, print, or share the completed form as needed.
Start filling out your Continuity Of Care Form - Anthem online today to ensure seamless health care!
Continuity of care is concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality, cost-effective medical care.