Get (ghp) Identification Form - Anthem

The Group Health Plan (GHP) Identification Form allows you to inform Anthem about your authorized representatives for discussing Protected Health Information (PHI). This guide provides step-by-step instructions for filling out the form online, ensuring a smooth process for your administrative needs.

Follow the steps to complete the GHP Identification Form online.

1. Press the ‘Get Form’ button to access the GHP Identification Form. This will open the document for you to begin filling it out.
2. In Section 1, provide the details for your Primary GHP Contact. Include the last name, first name, middle initial, role or title, phone number, and email address. Indicate if this contact will represent the GHP for all divisions by selecting 'Yes' or 'No.' If 'No,' specify which divisions they will cover.
3. In Section 2, fill in the information for the Alternate GHP Contact. Similar to Section 1, include the last name, first name, phone number, and email address. Again, note whether they represent all divisions.
4. Continue to Section 3 to add additional Alternate GHP Contacts if needed. Complete their last name, first name, phone number, email address, and role or title. Confirm if this contact will represent the GHP for all divisions.
5. In Section 4, list the designated broker or producer. Enter the agent's last name, first name, phone number, and email address.
6. Then, move to Section 5 to identify the Designated Third Party by filling in the last name, first name, phone number, and email address of the authorized vendor or consultant.
7. In Section 6, note all contacts who are no longer authorized. Provide their names and relevant details as required.
8. After completing all sections, ensure that the benefit administrator or decision maker provides their signature and the date at the bottom of the form. Your form will not be processed without this information.
9. Finally, review the form for any errors, then save your changes. You may choose to download, print, or share the form as needed.

Complete your GHP Identification Form online today for efficient processing.