Intel Transition of Care Form

Anthem Blue Cross (Anthem) is proud to be your medical carrier, committed to supporting you throughout your healthcare journey. To ensure a seamless transition to Anthem, we need to understand any specific health needs or medical conditions affecting you or your family. Whether you are currently receiving treatment for a condition (such as pregnancy, chemotherapy, radiation therapy, or behavioral health therapy), have special medication requirements, or an upcoming surgery, we are here to assist with any questions or concerns you may have. If you or a family member is undergoing or scheduled for care, please complete the following information. One of our Nurse Managers will get in touch with you. Please fill out the form completely, and submit a separate form for each family member who requires transitional care. If you do not have ongoing care needs, there is no need to complete this form.

  1. Genral Information

IntelReferrals@anthem.com

Email a Provider Experience associate.

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General Information

Disclosure

Please be aware that we (Anthem) are permitted to collect, use, and share your Protected Health Information (PHI) for treatment, payment, and health care operations purposes. In these situations, member authorization for the collection, use, and sharing of PHI is not required under the HIPAA Privacy rule. We are requesting the information on this form with the intent to reach out to your providers and hospitals to use, collect, and share your PHI as is needed for treatment, payment, and health care operations purposes. For additional information about how your information may be collected, used, and shared, please refer to the Notice of Privacy Practices sent to you upon your enrollment.

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