Condition Care

Our Condition Care team is based on a system of coordinated care management interventions and communications designed to assist physicians and others in managing members with chronic conditions.

Our mission 

The mission of the Condition Care department is to improve the health and quality of life for Anthem Blue Cross and Blue Shield members by encouraging member self-care efforts, coordinating healthcare education and providing interventions along the continuum of care.

Condition Care services include:

  • A holistic, member-centric approach to disease management focusing on the needs of the member through telephonic and community-based resources
  • Motivational interviewing techniques used in conjunction with member self-empowerment
  • The ability to manage more than one disease to meet the changing healthcare needs of our member population
  • Weight management and smoking cessation education

Who is eligible?

Members diagnosed with one or more of the conditions listed below are eligible for Condition Care services:

  • Asthma
  • Bipolar disorder
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive heart failure (CHF)
  • Coronary artery disease (CAD)
  • Diabetes
  • Hypertension
  • Major depressive disorder (MDD) for children, adolescents, and adults
  • Substance use disorder (SUD)
  • Schizophrenia

How can I refer a member to Condition Care?

To refer a member, fax a completed Condition Care Referral Form to 1-888-762-3199 or access the form via Availity .

Program objectives

Condition Care aims to:

  • Address gaps in care
  • Improve the understanding of disease processes
  • Improve the quality of life for members
  • Support collaboration to develop member-centered goals and interventions
  • Support relationships between the members and network providers
  • Increase network provider awareness of Condition Care programs
  • Reduce acute episodes requiring emergent or inpatient care
  • Identify social determinants of health and address by referring members to appropriate community resources

Our Condition Care programs feature:

  • Proactive identification process
  • Evidence-based Clinical Practice Guidelines from recognized sources
  • Collaborative practice models that include the physician and support providers in treatment:
    • Condition Care invites provider input for patient treatment plans. We provide you with Condition Care information and the most up-to-date Clinical Practice Guidelines to assist you in creating an individual plan of care
  • Continuous patient self-management education
  • Ongoing planning and communication with providers regarding patient status:
    • Providers can access Patient360 via Availity to obtain feedback on their patients regarding their care plans and condition management while enrolled in Condition Care programs
  • NCQA accreditation for nine of our programs, which incorporate outreach, education, care coordination, and follow-up to improve treatment compliance and enhance self-care

Contact us

  • Please call 1-888-830-4300 to reach a Condition Care case manager. Our Condition Care case managers are registered nurses.
  • Your patients can get information about Condition Care program services by visiting our member website or by calling 1-888-830-4300.
  • After hours, call the 24/7 NurseLine at 1-800-300-8181.



Hours of operation

Condition Care case managers are available from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday. Confidential voicemail and the 24/7 NurseLine are always available 24 hours a day.

Provider rights and responsibilities

You have the right to information about Anthem including:

  • Provided program and services
  • Our staff
  • Our staff’s qualifications
  • Any contractual relationships
  • How we coordinate our interventions with your patient’s treatment plans
  • How to contact the person who manages and communicates with your patients

You also have the right to:

  • Decline to participate in or work with any of our programs and services for your patients
  • Be supported by our organization when interacting with patients to make decisions about their healthcare
  • Receive courteous and respectful treatment from our staff
  • Communicate complaints about Condition Care as outlined in the Anthem provider grievances procedures, which can be located in the provider manual

Our Condition Care programs do not advertise, market or promote specific products or services to members or providers.

The Clinical Practice Guidelines (CPGs) for the chronic conditions listed above are available on Availity , our secure provider website. CPGs can be requested at any time.

Provider tools & resources

Interested in becoming a provider in the Anthem network?

We look forward to working with you to provide quality services to our members.