Get Hipaa Designated Contact Form - Anthem

This guide provides clear, step-by-step instructions on how to fill out the HIPAA Designated Contact Form for Anthem online. Designed for users with varying levels of experience, this document ensures you understand each section thoroughly.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by indicating whether you are adding or changing a designated contact person. Mark the appropriate checkbox next to your selected option.
3. Provide the company name and group number in the designated fields. Ensure accurate information as this identifies your organization.
4. Fill in the names, titles, addresses, phone numbers, fax numbers, and email addresses for each designated contact person. Remember to include full names, not just job titles.
5. If applicable, check the box to name a producer or broker as a designated contact person, and provide their details.
6. Obtain the signature of the Privacy Officer for the final approval of the information being submitted. Ensure the title, printed name, and date are filled out completely.
7. Complete the section for the designated contact for billing, providing the name and any additional contact information needed.
8. Once you have filled out the form, you can save your changes. The options to download, print, or share the completed form will allow you to keep a copy for your records.

Complete your HIPAA Designated Contact Form online now to ensure your organization remains compliant.