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Get Anthem 1685a 2013
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How to fill out the Anthem 1685A online
This guide aims to provide clear and comprehensive instructions on completing the Anthem 1685A form online. Designed for individuals transitioning to Anthem Blue Cross and Blue Shield, this guide will help ensure that your continuity of care is effectively documented.
Follow the steps to successfully complete your Anthem 1685A form online.
- Click the ‘Get Form’ button to access the Anthem 1685A form in your preferred online environment.
- Begin by filling out the Subscriber/Employer Info section. Enter the subscriber's name, effective coverage date, group number, employer name, and type of coverage, such as HMO or PPO.
- Next, proceed to the Patient Info section. Fill in the patient’s name, date of birth, patient ID number, home telephone number, work telephone number, and address. Also, indicate the best time to contact the patient.
- Move on to the Provider Info section. Input the primary care provider's name, address, and telephone number.
- If applicable, list any specialist information. Fill out the name, telephone number, and address of the first and second specialists.
- In the Services Requested for Transitional Care section, check all relevant care types that the patient is receiving or will require. Be thorough in this section to ensure all necessary services are documented.
- Provide a brief description of the active treatment being received in the space provided. This is critical for understanding the context of care.
- Answer the questions regarding case management. Indicate whether you are working with a nurse case manager and if you would like to be contacted by the Case Management Department at Anthem.
- Finally, ensure that the subscriber, guardian, or parent's signature is obtained where indicated, along with the date of signing.
- Once all fields are filled out, save the completed form as a digital file. You may print it out or share it as required. Make sure to submit it according to the instructions given, either by mailing it or faxing it to the specified numbers.
Complete your Anthem 1685A form online today to ensure seamless continuity of care.
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To find your Explanation of Benefits from Blue Cross, first log into your online account. Search for EOB documents under your claims history for easy access. If you cannot find the EOB, contact customer support for assistance. Using platforms like US Legal Forms can also provide you with useful tips on navigating your insurance documentation.
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