Anthem Logo Provider Maintenance Form December 08, 2022

 
If you are a Practitioner or Facility already participating with us and would like to make changes to your participation status or demographic record, please complete this Anthem [ https://www.anthem.com/provider/provider-maintenance-form/].
 
Note: To launch the provider maintenance form, you must use Google Chrome or Microsoft Edge.
 
If you are currently not participating with us, please read and follow the instructions below to apply.
 
Practitioner Network Participation
 
If you wish to become a contracted provider or add a provider to your existing group, please complete an Anthem digital provider enrollment application hosted on [https://availity.com].
 
Before you begin:
If your organization is not currently registered with Availity, the person designated as the administrator should go to [https://availity.com] and select Register. Availity administrator(s) will automatically be granted access to Anthem's digital provider enrollment in Payer Spaces.
 
If you are not an administrator and already using Availity, go to My Account Dashboard > My Account > Organization(s) > Administrator Information to find one. Your administrator will need to add Provider Enrollment to your user role in order to access Anthem's digital provider enrollment in Payer Spaces.
 
Apply online:
Log onto [https://availity.com] and select Payer Spaces > Anthem Blue Cross and Blue Shield > Applications > Provider Enrollment to begin.
 
After you apply:
All the information provided in Anthem's digital provider enrollment application will be used to determine contract eligibility. You will receive an application ID upon successful submission. Please use this application ID if you need to [https://www.anthem.com/provider/contact-us/].
 
Need assistance with Availity?
Log onto [https://availity.com/Contact-Us] or call Availity Client Services 800-AVAILITY (800-282-4548).
 
Ancillary or Facility Network Participation
 
Are you an ancillary provider or a Healthcare Delivery Organization (HDO)?
 
Do you currently participate in and want to update information or wish to apply for participation in the Medicaid State Sponsored networks and/or Healthy Indiana Plan (HIP) managed by Anthem?
 
Attention Anthem Blue Cross and Blue Shield of Kentucky Providers: If you currently participate in the state of Kentucky's Medicaid program or would like to enroll, please select "No".
 
 Yes
No
 
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Anthem Blue Cross and Blue Shield is the trade name for the following: In Indiana, Anthem Blue Cross® and Blue Shield® is the trade name of Anthem Insurance Companies, Inc. In Kentucky, Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. In Missouri, Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT) , Healthy Alliance Life Insurance Company (HALIC) and HMO Missouri, Inc. In Ohio, Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. In Wisconsin, Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin ("BCBSWi") and Compcare Health Services Insurance Corporation ("Compcare").

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