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  • Anthem Professional Individual/professional Group Change Request Form 2016

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Questions & Answers

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Contact support

Phone: (800) 541-6652, TTY 711, Monday – Friday, 8 a.m. – 5 p.m.

We'll send you an acknowledgement letter within three business days after we get your appeal. The letter will tell you we got your appeal request. You can also ask for an appeal by calling Member Services at 1-866-408-6131 (TTY 711).

The Provider Maintenance Form (PMF) is an online form used to request changes to existing practice profiles of Kentucky physicians, practitioners, professionals and ancillary professional providers with Anthem.

In California Anthem Blue Cross is the trade name of Blue Cross of California.

Health Plan SearchAnthem Blue Cross of California - Anthem Blue Cross HMO, also sometimes known as California Care or Rural Cal Care (includes CalPERS Traditional HMO)

Register with CAQH (if you are not already registered). You may self-register by visiting proview.caqh.org....A complete application includes: Your signature and application date. CAQH status of “Initial Application Complete” or “Reattestation” Current license to practice in each state where services are provided.

Care Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.

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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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