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  • US Legal Forms
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  • Anthem Provider Maintenance Form 2010

Get Anthem Provider Maintenance Form 2010-2025

Nd Practice Address City County State Zip Billing Address (if applicable, note same as ) City County State Zip Billing Email Address Billing Telephone Number Correspondence Address (if applicable, note same as ) City Add Delete Fax Number Billing Fax Number County New Tax ID number (if applicable) Practice Name State Zip National Provider Identifier Entity 2 (if applicable) Email Address Telephone Number Third Practice Address City County.

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How to fill out the Anthem Provider Maintenance Form online

Filling out the Anthem Provider Maintenance Form online is an essential step for healthcare providers wishing to update or maintain their information with Anthem. This guide will provide you with clear and detailed instructions on navigating each section of the form effectively.

Follow the steps to successfully complete the Anthem Provider Maintenance Form online.

  1. Press the ‘Get Form’ button to access the Anthem Provider Maintenance Form and open it in your preferred online editor.
  2. Begin by filling out Section F, Additional Office Location(s). Enter the practice name, new tax ID number (if applicable), and National Provider Identifier-Entity 2 (if applicable). Provide the email address, telephone number, and the second practice address, including city, county, state, and zip code. If applicable, note the billing address and billing email address. Don't forget to include the billing telephone number and correspondence address if it differs from above.
  3. In Section G, Covering Physicians, indicate if you wish to add or delete covering physicians who are not part of your practice’s tax ID. Enter the name and degree of the covering primary care physicians.
  4. Move to Section H, PA First Surgical Assistant, where you can add or delete the name of the PA First Surgical Assistant as needed.
  5. In Section I, Contact Signature, fill in the provider office contact name, fax number, specialty, National Provider Identifier number, supervising physician’s name, effective date, supervising physician’s NPI, and telephone number. Finally, sign and date the form, indicating your authority to request the changes.
  6. Before submission, review the completed form to ensure all required fields are accurately filled. Incomplete forms may be returned for additional information. Once reviewed, you can save the changes, download, print, or share the form as required.

Complete the Anthem Provider Maintenance Form online and keep your provider information up to date.

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Contact support

To find your Anthem provider representative, you can visit the Anthem website or contact their customer support for assistance. They typically provide resources that direct you to the appropriate representative for your region. As you navigate this process, remember that your Anthem Provider Maintenance Form may often be a topic of discussion with your representative, ensuring that all your updates are in order.

PMF stands for Provider Maintenance Form. This form is essential for any healthcare provider working with Anthem to keep their records accurate and up-to-date. Regularly submitting the Anthem Provider Maintenance Form helps ensure seamless processing of claims and timely updates to patient information.

The form of PMF is typically a downloadable document that providers fill out to communicate changes to Anthem. While it may vary slightly based on the region, it generally includes sections for entering detailed provider information and necessary updates. By utilizing the Anthem Provider Maintenance Form, you ensure that your practice stays compliant and connected with Anthem's systems.

A PMF allows providers to update various aspects of their practice, such as contact details, service offerings, and provider networks. This is crucial for maintaining effective communication between providers and patients, as well as reducing errors in billing and claims processing. Using the Anthem Provider Maintenance Form can streamline these updates significantly.

Changing your doctor on Anthem Blue Cross involves selecting a new provider from their network and updating your records. To facilitate this change, complete the Anthem Provider Maintenance Form, where you can specify your new doctor's information. Ensuring your records are up to date makes it easier to receive care tailored to your needs. After submission, Anthem will confirm the transition.

To change your provider address with Anthem, you must complete the Anthem Provider Maintenance Form. Clearly indicate your existing address and the address you want to change to. This information is crucial for maintaining accurate records and communication. Once received, Anthem will process your request and notify you once the changes are made.

To change your name in Anthem insurance, you need to complete the Anthem Provider Maintenance Form. This form collects your new name details and ensures your records are updated accordingly. Make sure to include any legal documents that verify the name change, such as a marriage certificate or court order. Once submitted, Anthem will process the changes and confirm the update.

To obtain the Anthem 1095 A form, you can visit the Anthem website or contact their customer service for assistance. This form is necessary for reporting health coverage on your tax returns, so make sure to request it in a timely manner. Be aware that you may receive this form by mail if you had coverage during the year. If needed, the Anthem Provider Maintenance Form can also help ensure that your address is updated for future correspondence.

To update your provider address with Anthem, you need to fill out the Anthem Provider Maintenance Form. This form captures the essential details required for processing your request. It’s important to submit this form promptly to avoid any interruptions in your communications and claims processing. After submission, confirm that your new address is updated in their system.

Various insurances, including some plans offered by Anthem, enforce a 90-day timely filing limit for claims submissions. This policy can vary by plan, so it's crucial to verify the specifics of each policy you encounter. To avoid complications, providers should stay informed about these limits. The Anthem Provider Maintenance Form can assist in maintaining accurate records of claims submissions.

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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