Get Medicare Secondary Payer Employer Status Form - Anthem

Filling out the Medicare Secondary Payer Employer Status Form - Anthem online can streamline the compliance process with Medicare Secondary Payer regulations. This guide will walk you through each step of completing the form to ensure accurate submission.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the form and open it in your editing interface.
2. Begin by entering the group name in the designated field. This should reflect the official name of the business or organization.
3. Provide the group contact's information by filling in the relevant fields with a name and a reliable telephone number.
4. Fill in the group identification number, which is crucial for identifying the group within the Anthem system.
5. In the section regarding employee numbers, select the appropriate option indicating whether the group has 20 or more employees working each week.
6. Next, indicate if the group has 100 or more employees working on at least 50 percent of its regular business days during the previous calendar year.
7. Clarify the total number of employees, including part-time, full-time, and leased employees, by entering the exact number in the provided space.
8. Enter the date when the employee count was determined. This date should reflect when the last calculation was made.
9. If there have been any changes in the employee count category, ensure to attach the latest wage and tax statement to the form.
10. Finally, the group administrator must sign and date the form to certify that the information is accurate to the best of their knowledge.
11. After completing the form, save your changes. You may also choose to download, print, or share the completed form as needed.

Start filling out your Medicare Secondary Payer Employer Status Form - Anthem online today to ensure compliance.