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Anthem Blue Cross : Provider Forms

Provider Forms

*Medicare Advantage Products never require Pre-Existing Condition signoff 
Beneficiary Notice Forms  
Medicare Part D Rx Coverage Determinations and Appeals 
Providers can send a request for a prescription coverage determination or an appeal for a Medicare plan via email rather than fax or phone by sending the request to the following address:  

® Anthem is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association © 2011 Anthem Blue Cross.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.