SSBCI Chronic Condition Verification Form, HMO D-SNP PDF
Form and criteria for verifying member eligibility for Special Supplemental Benefits for the Chronically Ill (SSBCI) for Anthem Blue Cross HMO D-SNP members. Defines eligible chronic conditions and functional/hospitalization criteria that must be documented by a provider and submitted via fax, upload, or mail.
No material clinical or coverage changes
Coverage summary — SSBCI verification
This form and criteria apply to Anthem Blue Cross HMO D-SNP members for verification of eligibility for Special Supplemental Benefits for the Chronically Ill (SSBCI). The policy stance is covered with criteria: members with one of the listed eligible chronic conditions who meet the defined utilization, functional, or equipment needs criteria may qualify. The form must be completed and submitted by the provider via fax, upload, or mail to verify SSBCI eligibility.