ProviderAccess Login
Access our secured site.
Not registered? Register Now


Login
Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.

Enter

Find a Doctor
Search our online provider directory when you need a doctor, hospital or other health care provider.

Customer Service

PW_002161

 
Subsections:

ProviderAccess

Anthem’s ProviderAccess functions provide helpful online tools that let Providers get claims and eligibility information without calling our customer service units. Our goal in offering these online options is to help make it easy for you to do business with us. 
Our ProviderAccess online services are available at anthem.com and include the following: 
Check local, FEP and BlueCard® member eligibility and benefits
View benefits used for local members
Check claim status
Run claim reports for local claims
Online pricing
 
Advantages of ProviderAccess
It’s free.
Your office doesn’t need any special programming or software. All you need is Internet access.
You don’t have to wait on the phone to speak to customer service.
It helps you reconcile your accounts receivable with claim reports.
There’s no limit to the number of claim status inquiries, because ProviderAccess allows you to check as many claims as you want, whether they were submitted on paper or electronically.
There is no limit to the number of member eligibility inquiries, because ProviderAccess allows you to check eligibility for as many members as you want.
There are no requirements to be contracted with Anthem to use this tool.
 
How to Get Started with ProviderAccess

1. Go to anthem.com.

2. Click the Providers tab, and select Nevada from the state drop-down box.

3. Click Enter.

4. Click on the “Register Now” link on the left in the blue login area.

5. Complete the registration online. You will receive confirmation within 1 business day.

 
Passwords
A password is required to access the screens on our ProviderAccess site. Passwords can be retrieved and reset online without making a phone call to support. 
We have dedicated associates in our ProviderAccess support department who will educate you and your staff about how to access Anthem’s ProviderAccess site, verify eligibility, check claims status, and print reports on all paper and electronic claims.  
For ProviderAccess questions or issues, please call the ProviderAccess Support team at 866-302-1384. 
 

ProviderAccess Quick Reference Guide

Logging on to ProviderAccess

1. Go to anthem.com.

2. Click the Providers tab, and select Nevada from the state drop-down box.

3. Click Enter.

4. Click on the login button in the blue login area located in the left side of the page.

5. Click OK in the security pop-up box.

6. Enter your user name and password. Note: These fields are case-sensitive.

7. Click LOGIN.

 
How to View Local Member Eligibility and/or Benefits

1. Select the Eligibility & Benefits tab to search using the member’s ID number. For local members only, you can also select “Name Search” to search by the member’s first and last names and date of birth. Note: You must use the exact spelling of the member’s first and last names, as well as any hyphens if they’re part of the name.

2. Enter the member’s ID number

3. If all members on the contract are returned, locate the member you wish to view and select “Plan Summary” from the drop down list, and benefits will be displayed.

4. For more eligibility information, click “Benefit Detail”

5. Select “Benefits Used” to display member benefits used to date, such as deductible and coinsurance, as well as benefit limits that have been used.

 
How to View Local Member Claim Status

1. Select the claims tab

2. Enter the member ID number

3. If you have alternate tax IDs loaded, select the tax ID number for the claim from tax ID drop-down box

4. To search by date of service, enter the date range in MM/DD/YYYY format.

5. Click Search to display status information for the selected member claim(s).

6. For more detailed claim information, click actions.

For additional help with ProviderAccess, please call the ProviderAccess support department between 8 a.m. and 5 p.m. Monday through Friday. 
 

Primary Care Physician Change Request

HMO Nevada members can select a primary care physician (PCP) of their choice from the HMO Nevada network. However, we carefully evaluate frequent PCP change requests, because changes may disrupt continuity of care, promote adverse risk transference and add administrative complexity and cost. We research and respond to grievances and complaints in accordance with HMO regulations, reinforcing our commitment to a quality health care system. 
Customer service grants and processes PCP change requests. 
Excessive PCP change requests from members related to potential quality issues or grievances and complaints about a particular Provider aren’t permitted until an investigation is completed, or the grievance and complaint or provider services department notifies customer service.  
 
Procedure
A member can request to change PCPs by calling HMO Nevada’s customer service department.
If the member indicates a potential quality issue or grievance and complaint at the time of the change request, customer service will ask the member to submit additional information in writing about the potential quality issue or grievance and complaint. If we receive a written potential quality issue or grievance and complaint, we’ll send it to the grievance and complaint department for research. A grievance and complaint department associate will communicate HMO Nevada’s resolution/action related to the potential quality issue or grievance and complaint to the member and to the Provider. A copy of this correspondence will be maintained in the grievance and complaint department’s confidential files.
Please allow at least 30 calendar days for research and processing of the potential quality or grievance and complaint issue that requires investigation.
Customer service will process the member’s PCP change request and, if approved, the effective date of the change.
When a member changes PCPs in a month during which the member has already seen the previously selected PCP, the member can’t see the new PCP until the first of the following month. The member will be responsible for payment of any subsequent visits to the previously selected PCP until the beginning of the following month.
 

Member Notification Regarding Provider Termination

When a Provider contract is terminated, Anthem will notify members that require continuation of care. 
 

Provider File and Online Directory Management

Our searchable online provider directory lists physicians, hospitals and other health care professionals in our networks. The provider directory provides the most up-to-date information available about in-network providers.  
We invite you to check your own listing in our online provider directory to ensure the information we provide to our members about you is accurate. If any of your information is incorrect, please complete the Provider Change Form. You must submit any provider file updates, i.e., address change, TIN change, etc., in writing and with a new W-9 form. Mail or fax the completed form to the following address or fax number:  
Anthem Blue Cross and Blue Shield 
6900 Westcliff Drive, Suite 600 
Las Vegas, NV 89145 
Fax: 702-228-1257 or 866-767-9851 
Please include your full name, tax ID number and ZIP code so we can easily identify you and promptly update your file.  
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

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