Our Case Management program is a collaborative effort providing assistance to both providers and members in the coordination of complex healthcare. The program is designed to educate and assist members to become empowered, exercise their options to access appropriate services and optimize their healthcare benefits to meet individual health needs.
Your patients may already be working with one of our case managers. If not, or if they need help contacting their case manager, please have them contact Member Services.
Providers, nurses, social workers, and members or their representatives may refer members to case management by calling Anthem Blue Cross and Blue Shield (Anthem) Medical Management.
Our case managers may call members if:
- They or you, their healthcare provider, think case management might help the member.
- They’ve just gotten out of the hospital and need help with follow-up visits to other doctors.
- They’re going to the emergency room (ER) often for nonurgent care that could be handled by you, their healthcare provider.
- They call our 24/7 Nurse HelpLine and need more follow-up for ongoing care.
- They have serious physical problems and need more help managing their health.
- They have behavioral health problems and need more help working with all their doctors.
When calling members, our case managers will:
- Always identify themselves by name, title and position with Anthem.
- Tell the member about the services we offer.
- Talk to the member about their health and how they’re handling different parts of their life.
Case managers can help you with:
- Setting up healthcare services for the member
- Getting referrals and prior authorizations
- Checking a member’s plan of care