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  • Enrollment Application - Anthem

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Enrollment Application Group size 51+ eligible employees INSTRUCTIONS: Please read carefully, complete electronically, or in blue or black ink, all the required sections and return to your employer.

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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.

If you have questions about this form or need additional assistance, contact Provider Services at (844) 396-2330 or contact your local Provider Experience Consultant.

If you have questions about this form or need additional assistance, contact Provider Services: 866-408-6132 for Hoosier Healthwise, 844-533-1995 for Healthy Indiana Plan, or 844-8284-1798 for Hoosier Care Connect; or contact your local Provider Experience Consultant.

Credentialing Process Register with CAQH (if you are not already registered). You may self-register by visiting proview.caqh.org. ... Authorize Anthem so we can access your credentialing information. ... Review and update your application.

Anthem follows the standard of: • For participating providers — within the 180 day timely filing period. For nonparticipating providers — within the 365 day timely filing period.

and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (collectively “BCBSGa”) has changed to Anthem Blue Cross and Blue Shield (Anthem), a trusted name that symbolizes quality for millions of consumers across the country. While our trade name and logo have changed, almost everything else will stay the same.

Care Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.

Activating your HSA From the Account Summary page click the “Activate Your HSA” link at the bottom of the page. 2. Review and/or update your personal information. If you have a PO Box as a mailing address you should provide a residential or physical address in the Residential Address fields.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232