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If your medical or behavioral health provider is currently not a Blue Cross and/or Blue Shield provider, you may nominate your provider by printing this provider nomination form and faxing it to Anthem at 513.682.8810 or by mailing it to:  Anthem Motorola Account Team, 9075 Centre Point Drive, Suite 200, West Chester, OH 45069-4861. 
 
Anthem Blue Cross and Blue Shield is accepting provider nominations from Motorola participants through December 31, 2009. The complete nomination time is approximately three (3) to six (6) months from the time your nomination is received until the time your provider is accepted or not accepted for network participation. Your provider will be contacted shortly after Anthem receives your nomination form. Nomination of a medical or behavioral health provider does not guarantee network participation. It is an individual business decision by the medical or behavioral health provider. Some providers may not be willing to accept discounted rates. It is also important to note that a small percentage may apply but not meet the credentialing standards. 
 
Anthem is in the process of conducting provider outreach to providers seen by a Motorola member last year that are not currently participating in the National Blue Card Network. Please check the Motorola Non Participation Provider listing to check the status of the outreach. 

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