Get Anthem Provider Maintenance Form 2010-2026
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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.
- Press the ‘Get Form’ button to access the Anthem Provider Maintenance Form and open it in your preferred online editor.
- 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.
- 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.
- Move to Section H, PA First Surgical Assistant, where you can add or delete the name of the PA First Surgical Assistant as needed.
- 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.
- 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.
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.