Claims and Correspondence Mailing Addresses - Anthem

Page 1
Claims and Correspondence Mailing Addresses
Type of Plan Service Unit Telephone Number
Anthem Blue Cross HMO
(CaliforniaCare)
Customer Service 800-288-6921
Anthem Blue Cross HMO
Preferred (HMO POS)
Anthem Blue Cross POS
(Anthem Blue Cross PLUS)
Anthem Blue Cross PPO
(Prudent Buyer Plan) Large
Group Members
Anthem Blue Cross
Individual
Anthem Blue Cross Small
Group
Anthem Blue Cross Federal
Employees Program (FEP)
BlueCard (Out-of-Area
Blue Cross and Blue Shield
= Applies to HMO
l
Customer Service 800-288-6921
Customer Service 800-288-6921
Customer Service
Customer Service 800-333-0912
Customer Service 800-627-8797
Customer Service 800-322-7319
Eligibility Line
Use the Customer Service
telephone number on the
member’s identification card.
800-676-BLUE or
800-676-2583
members) Claim Status 800-444-2726
EDI Claims Submission Customer Service 800-227-3983
Healthy Families and
Medi-Cal
Senior Secure Plans
Workers’ Comp Managed
Care Services (WCMCS)
Health Care
Professional/
Member Services
Anita Dominick, Senior
Regulatory Specialist
800-845-3604
805-480-7054
Bill Review Service 800-422-7334
In an effort to make medical claims submission faster and easier, Anthem Blue Cross (Anthem) uses
the following mailing addresses for claims and claims-related correspondence:
Service Area Mailing Address
All claims and claims-related
correspondence, except for Federal
Employee Programs, Stop Loss, Pharmacy
and Third-Party Administrator Professional
Anthem Blue Cross
P.O. Box 60007
Los Angeles, CA 90060-0007
= Applies to Senior Secure
Only

Claims and Correspondence Mailing Addresses
Service Area Mailing Address
All claims and claims-related
correspondence for Federal Employee
Programs
Claims and correspondence via Federal
Express, registered or certified mail, etc.
All Workers’ Compensation-related
correspondence
Senior Secure claims and claims-related
correspondence
Contract Management
*Check your contract for verification and details.
Page 2
= Applies to HMO Only
Anthem Blue Cross - FEP
P.O. Box 70000
Van Nuys, CA 91470
Anthem Blue Cross /name of product
21555 Oxnard Street
Woodland Hills, CA 91367
Anthem Blue Cross
Workers’ Compensation Managed Care Services
2170 Towne Center Drive, Suite 320
Anaheim, CA 92806
Anthem Blue Cross /Senior Secure
P.O. Box 60007
Los Angeles, CA 90060-0007
Anthem assigns a contract manager to act as a liaison between the medical group or IPA and
Anthem. The contract manager is responsible for:
1. Renegotiating the Anthem Blue Cross HMO Medical Services Agreement as necessary.
2. Negotiating and annually renegotiating the Anthem Blue Cross Senior Secure Medicare
Advantage Medical Services Agreement (for Noncap)/Anthem Blue Cross Senior Secure Medicare
Advantage Professional Services Agreement (for Dual Risk)*.
3. Arranging status meetings with a medical group’s administrator and/or staff to resolve any
outstanding contract-related (excluding claims adjudication for Senior Secure) issues.
4. Identifying new network expansion sites and managing negotiations to recruit prospective
physician groups.
5. Monitoring existing physician/medical groups’ membership limits and negotiating with
physician/medical groups for additional availability or other alternatives for ensuring
adequate physician coverage.
6. Working with Quality Management Operations to monitor the physician/medical group’s
quality management programs.
7. Keeping abreast of new physician/group enrollment and any issues that may impact Health
Care Management.
8. Working with Anthem’s Network Relations department and/or Anthem’ Health Care
Management staff regarding outside contract matters, hospital discounts, or other issues
raised by any of the hospital associations.
9. Coordinating activities related to contract disputes and other legal matters with the
Anthem Legal department and associated medical providers.
= Applies to Senior Secure Only

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Claims and Correspondence Mailing Addresses
Credentialing
Area Telephone
Anthem Blue Cross Credentials Committee
Richard Lehrfeld, MD, JD, Staff Vice President,
Medical Director, Chairperson
818-234-4430
Karla Enrequez, Director, Credentialing
(for delegated Credentialing, see Quality Operations below)
818-234-6806
Customer Service
Customer Service associates are available to medical group offices and other health care staff to
answer both written and telephone inquiries on a variety of topics, including:
• Benefit questions and explanations
• Eligibility verification and research, medical group eligibility, and effective dates
• Professional services, billing and claims status
• Hospital services, billing and claims status
• Prescription drug benefits, eligibility and claims process
• Requests for removal of members for disciplinary actions
• Conflict resolution regarding benefit interpretation
• Member removal at physician request
• Assistance in accessing services that may not be delegated to the medical group, such as
professional outpatient behavioral health)
Area Telephone
HMO Customer Service Department for providers only 800-677-6669
Customer Service Department for Members Only Use the telephone number on the
member’s ID card
Direct Senior Secure-related medical group, hospital and other ancillary health care
professional inquiries to Anthem Blue Cross Senior Secure’s Customer Service department.
= Applies to HMO
l
= Applies to Senior Secure
Only

Claims and Correspondence Mailing Addresses
Use the Customer Service telephone number on the member’s ID card. If that information
is not available, use the following number:
Area
Anthem Blue Cross Senior Secure Customer Service
Telephone
888-230-7338
Area Area
Department of Managed Health Care
The California Department of Managed Health Care (DMHC) is responsible for regulating health
care service plans. For more information on grievance procedures, see the Grievance and Appeals
Management section in the provider operations manual.
Health Plans Division Complaints
*Check your contract for verification and details.
Page 4
Service Contact
= Applies to HMO Only
Telephone: 888-HMO-2219
or 888-466-2219
Fax: 916-229-0465
Health Plans Division California Relay Service Telephone: 877-688-9891 (TDD)
The DMHC’s Website (online complaint forms and
instructions)
Mailing Address
Department of Managed Health Care
California HMO Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
EDI
www.hmohelp.ca.gov
Area/Contact Telephone
Electronic Claims Submission 800-227-3983
Encounter Data Submission
Rose Hutchinson, Senior EDI Account Manager
818-234-3637
EDI “LivePerson” Live Chat
If you have Internet access in your office, Anthem offers LivePerson. For assistance with EDI
transactions, doctors and other health care professionals, simply connect to the Anthem Blue Cross
website, navigate to the EDI page and click on the button labeled “Live Help.” The “LivePerson”
tool can also be accessed by the following path: www.anthem.com/ca/home-providers.html
.
= Applies to Senior Secure Only

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Claims and Correspondence Mailing Addresses
Grievance and Appeals Management
Area/Contact Telephone
HMO Medical Grievance and Appeals
Theresa Peterson, Manager
818-234-3095
Medical Grievance and Appeals Management
Ron McGinnis, Director
818-234-3125
Grievance and Appeals Management Specialists 800-365-0609
Mailing Address Fax
Anthem Blue Cross
Attn: Grievance and Appeals Management
818-234-4084
P.O. Box 4310
TTD/TTY line:
Woodland Hills, CA 91365-4310
877-247-1657
Health Care Informatics
Contact Telephone
Peter Lee, Director 818-234-2154
Health Management Programs
Area/Contact Telephone
Enrollment for Health Management Programs 800-522-5560
Mailing Address
Health Management Programs
Anthem Blue Cross
Attn: Health Management Programs
P.O. Box 4413
Woodland Hills, CA 91365-4413
Medical Policy and Technology
Area/Contact Telephone
Medical Policy and Review
312-234-7026
Alan Rosenberg, MD, Vice President,
Medical Director
Network Education, Training and Development
In 2007, the Network Education, Training and Development department (NETD) will begin
offering online courses. NETD incorporates cutting-edge technology, which will make the
information you need to have more dynamically accessible through the use of online e-learning and
= Applies to HMO
l
= Applies to Senior Secure
Only

Claims and Correspondence Mailing Addresses
computer-based training courses. All you need is a computer with Internet access to take advantage
of these learning opportunities.
Telephone Fax E-mail
(818) 234-1016 818-234-8959 network.education@
wellpoint.com
For ancillary, e-mail:
ancillarynetworks@wellpoint.com
Network Relations and Service
Network Relations is the liaison between Anthem Blue Cross (Anthem) and participating medical
groups, hospitals and physicians.
Network Relations associates are available to assist you with contract interpretation questions,
requests for educational workshops or on-site visits, and issue resolutions that requires escalation,
(i.e., normal channels for resolving issues have been exhausted). You can reach the Network
Relations department by telephone Monday through Friday, 9 a.m. to 4 p.m. PST, at
800-933-6633. If you are calling from a participating medical group, select option #3, then
option #1.
You can also e-mail Network Relations at networkrelations@wellpoint.com. Please include the
following information to expedite our response to you:
• Provider’s tax identification number(s)
• The nine-digit Tax ID number of the medical group, physician and institution
• Institutions should also provide their six-digit Medicare ID number
• Provider’s name and address
• Complete contact name (company name, if not the same as provider) and phone number,
including extension
• Patient’s name (when applicable)
• Patient’s Health Care Identification (HCID) number
• Dates of Service
• Total charges
Network Relations can respond to questions or complaints regarding Anthem’ operations and
policies including, but not limited to, noncapitated claims reporting, noncapitated performance
settlements, encounter reporting, capitation payments, eligibility and enrollment protection claims.
To forward correspondence via Federal Express, or registered or certified mail, etc.:
Mailing Address
*Check your contract for verification and details.
Page 6
= Applies to HMO Only
= Applies to Senior Secure Only

Page 7
Claims and Correspondence Mailing Addresses
Anthem Blue Cross
Attn: [Name of Product, Specific Department]
21555 Oxnard Street
Woodland Hills, CA 91367
Pharmacy Management
Contact Telephone Number E-mail Address
WellPoint Pharmacy
Management Formulary
Request
800-700-2541
N/A
WellPoint Pharmacy
Management Customer
Service
800-700-2541 N/A
WellPoint Pharmacy Telephone:
N/A
Management Prior 888-831-2242
Authorization of
Pharmacy Benefits (PAB)
Program Center
Fax: 888-831-2243
PrecisionRx Specialty 800-870-6419 www.precisionrxspecialtysolutions.com
Solution Drug List
A list of specialty drugs and a fax form is
located near the bottom of the page.
PrecisionRx Specialty 800-870-6419
www.precisionrxspecialtysolutions.com
Solution Customer
Service
For speech and hearing
impaired assistance
(TDD/TTY), please call
800-221-6915.
Preventive Health Services
Area/Contact Telephone
Preventive Health Services
Beena Thomas, Director
404-467-2911 x72911
Provider Care
The Provider Care department assists hospitals and medical groups with a variety of administrative
issues, including:
1. Eligibility verification and research
2. Benefits questions and explanations
= Applies to HMO
l
= Applies to Senior Secure
Only

Claims and Correspondence Mailing Addresses
3. Claims status and claims adjustment inquiries
Department Telephone Number
Provider Care 800-677-6669
The hours of operation for Provider Care Customer Service are:
Monday through Thursday
Friday
Saturday, Sunday, and Holidays
Provider Database Operations
*Check your contract for verification and details.
Page 8
= Applies to HMO Only
8:00 a.m. to 5:00 p.m.
8:30 a.m. to 5:00 p.m.
Closed
The Provider Database Operations area updates addresses, telephone numbers, tax identification
numbers, and directory listings for medical groups, physicians and other health care professionals
that are contracted with the Anthem HMO and Senior Secure networks.
Using your own letterhead, fax changes to the following numbers:
Practice Location Fax Number
Northern California Counties 818-234-2836
Southern California Counties 818-234-2935
Note: All changes must be signed by the physician.
The Provider Database Operations department can also assist with the following situations:
1. Health care professional’s checks mailed to incorrect address
2. A physician has been added to the practice
3. Changes to a health care professional’s hospital staff privileges
Note: To check on the status of an application, call the Credentialing Status Inquiry Line at
877-841-8386 or via e-mail at providerdatabase-bcc@wellpoint.com.
= Applies to Senior Secure Only

Page 9
Claims and Correspondence Mailing Addresses
Quality Improvement
The Quality Improvement Program strives to support, not interfere with, the patient-physician
relationship that ultimately drives all quality improvement.
Contact Telephone Number E-mail Address
Quality Management Program 877-273-4189
Jennifer Curtis,
Director, Quality Improvement
Colleen Patania,
Manager, Quality Improvement
Mailing Address
Anthem Blue Cross
Quality Improvement Department
21555 Oxnard Street AC-12G
Woodland Hills, CA 91367
= Applies to HMO
l
805-557-5481 Jennifer.Curtis@Wellpoint.com
925-927-6059 Colleen.Patania@Wellpoint.com
Quality Operations (PMG Delegation Oversight, Including
Credentialing and Utilization Management)
Area/Contact Telephone
Quality Operations
805-557-6784
Julie Theodore, Director
Quality Management
818-234-4056
Suzanne Zelazny, Manager
If you need to speak to a Quality Management Audit Nurse (QMAN), contact Suzanne Zelazny and
she will direct you to the appropriate QMAN.
= Applies to Senior Secure
Only

Claims and Correspondence Mailing Addresses
Senior Secure
Member Services Information for Anthem Senior Secure
Department Telephone Number
Anthem Blue Cross Senior Secure Member
Services
The hours of operation are:
Monday through Thursday
Friday
Saturday and Sunday
Utilization Management
*Check your contract for verification and details.
Page 10
= Applies to HMO Only
888-230-7338
8:00 a.m. to 6:00 p.m.
8:00 a.m. to 3:00 p.m.
Closed
Area/Contact Telephone
Medical Policy and Review
312-234-7026
Alan Rosenberg, MD, Vice President,
Medical Director
Utilization Management, Medical Review and 818-234-4108
Preferred Provider HMO Networks
Zeinab Dabbah, MD, Medical Director
Provider Line, Utilization Management Telephone: 800-274-7767
Hours of Operation: 6:30 a.m. to 5:30 p.m. a.m. Fax: 866-815-0839
to 5:30 p.m.
Specialty Drug Pre-Service Medical Review Telephone: 800-274-7767
Program
Note: Anthem pre-service medical review
request forms are required. No other pre-service
review request form will be accepted.
Drug list and pre-service medical review request
forms
Website Address
www.anthem.com/ca
The Anthem Blue Cross website is www.anthem.com/ca (featuring ProviderAccess, pharmacy
information, medical policy, and much more).
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance
Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark. ® The Blue Cross name and symbol
are registered marks of the Blue Cross Association © 2007 Anthem Blue Cross.
= Applies to Senior Secure Only