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Advanced Practice Nurse (APN) Application

PW_B142661

Becoming an Anthem Blue Cross and Blue Shield Network Provider

Thank you for your interest in becoming a network provider with Anthem Blue Cross and Blue Shield. Along with our subsidiary company, HMO Colorado, Inc., we seek to establish contracts with exceptional providers, and look forward to working with you to provide quality service for our members.  
Steps in the APN Application Process: 
As a potential Anthem network provider, you must meet the following requirements and follow the application instructions listed below:  

Liability insurance with a coverage minimum of $1,000,000 per claim and $3,000,000 aggregate

Arrangement for referral for inpatient coverage

An unrestricted state license

Diploma or Certificate of Training identify the category of APN

W-9 form

 

Please complete this application (all information is required), and fax it and all the required documents to Anthem Blue Cross and Blue Shield’s provider contracting department at 303-8315833.

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use