Anthem Online Provider Services
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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.
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Find a Doctor
Search our online provider directory when you need a doctor, hospital or other health care provider.
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Contact Us
PW_M010364
If you cannot find what you are looking for on our Online Provider Services Web site, use this guide to determine the appropriate provider service center for your inquiries.
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Provider Call Center (local Anthem plans)
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Professional
Eligibility, benefits and claims
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8:00 a.m. - 5:00 p.m.
Monday - Friday
(IVR available 24/7)
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1-800-922-3242
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XG*, CKC, OTW, PHT, PRG, URR
*third alpha character will vary
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Institutional
Eligibility, benefits and claims
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8:00 a.m. - 5:00 p.m.
Monday - Friday
(IVR available 24/7)
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1-800-345-2227
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Medical Management
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8:00 a.m. - 5:00 p.m.
Monday - Friday
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1-800-238-2227
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New England Health Plan (NEHP) and **Empire HMO plans
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Eligibility and benefits
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8:00 a.m. - 5:00 p.m.
Monday - Friday
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1-800-676-BLUE (2583)
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CTN, CTP, EHF, EHG, EHH, EHJ, MEN, MEP, MTN, MTP, NHN, NHP
**Empire prefixes – POP, POS, YLF, YLL, YLQ
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Claim inquiries
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8:00 a.m. - 5:00 p.m.
Monday - Friday
(IVR available 24/7)
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1-800-238-2465
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Medical Management
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8:00 a.m. - 5:00 p.m.
Monday - Friday
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1-800-238-2227
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Tri-state
Anthem plans in Connecticut, Maine and New Hampshire utilize the same membership and claims systems, therefore, inquiries for Maine and New Hampshire members are considered local or ‘tri-state’ inquiries. Please contact the following numbers for the specified prefixes.
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Anthem Maine (tri-state)
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8:00 a.m. - 5:00 p.m. Monday - Friday
(IVR available 24/7)
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1-800-832-6011
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XVA, XVB, XVG, XVH, XVP
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Anthem New Hampshire (tri-state)
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8:00 a.m. - 5:00 p.m.
Monday – Friday
(IVR available 24/7)
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1-800-332-6558
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YGA, YGC, YGF, YGG, YGK, YGM
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BlueCard® Service Center
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Eligibility and benefits
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8:00 a.m. - 5:00 p.m.
Monday - Friday
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1-800-676-BLUE (2583)
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All prefixes not listed elsewhere in this grid
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Claim Inquiries
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8:30 a.m. - 5:00 p.m.
Monday - Friday
(IVR available 24/7)
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1-800-895-9915
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Precertification
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1-800-676-BLUE (2583) Option 4
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Taft-Hartley / Teamsters
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Eligibility, benefits and claims
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8:00 a.m. - 5:00 p.m.
Monday - Friday
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1-888-287-0032
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CCU, CWV, ELH, EWU, IRU, IUB, IUP, NEF, NEH, NIW, PSH, PTH, SVL, TLH, TSJ
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Precertification
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See member’s ID card
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Federal Employee Program® (FEP)
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Eligibility, benefits and claims
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Mon - Wed., Friday,
8:00 a.m. - 5:30 p.m.
Thursday, 9:00 a.m. - 5:30 p.m.
(IVR available 24/7)
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1-800-438-5356
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R (followed by 8 digits)
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Advance benefit determination
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8:00 a.m. - 7:00 p.m.
Monday - Friday
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1-800-860-2156
Fax 1-877-606-3807
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Transplant prior approval (including bone marrow)
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8:00 a.m. - 4:30 p.m.
Monday - Friday
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1-800-688-1019
Fax 1-800-447-5523
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Precertification (acute inpatient admissions, concurrent review & outpatient cardiac rehabilitation
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8:00 a.m. - 7:00 p.m.
Monday - Friday
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1-800-860-2156
Fax 1-800-732-8318
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Case management
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8:00 a.m. - 7:00 p.m.
Monday - Friday
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1-800-711-2225
Fax 1-877-276-1608
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MediBlueSM HMO
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Eligibility, benefits and claims
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8:00 a.m. - 8:00 p.m.
Monday - Friday
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1-866-673-4157
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XGH
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Precertification
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1-877-657-6115
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MediBlueSM PPO
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Eligibility, benefits and claims
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8:00 a.m. - 8:00 p.m.
Monday - Friday
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1-866-673-4157
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XGK
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Precertification
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1-877-657-6115
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Medicare Advantage other HMO and PPO plans throughout the United States
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varies by state
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see member’s ID card
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varies by state
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 | Password changes or requests |
| Online Provider Services navigation questions |
| Transmission or connection support for EDI services |
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Anthem Online Provider Services (AOPS)
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1-866-755-2680
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Availity
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1-800-282-4548
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1-800-334-8262
Or EDI.ENT.Support@anthem.com
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Anthem Behavioral Health
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1-800-934-0331
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Anthem Dental
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1-800-548-0642
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Anthem Vision
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1-888-799-6290
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AIM Specialty Health
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1-866-714-1107
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OrthoNet (PT, OT authorizations)
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1-888-788-0807
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Click here for a complete list of Professional Provider Network Relations Consultants’ territories by town.
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Shannon Dill
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203-677-8054
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Haydee Garayua
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203-677-8057
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Lilliam Garayua
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203-677-8058
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Jacqueline Hillman
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203-677-8059
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Catherine Hesbach
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203-677-8060
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Internal Professional Relations Network Management Representative
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Michele Baksa (professional contracting inquires)
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203-677-8045
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Click here for a complete list of Institutional Network Relations Consultants’ territories by facility.
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