Anthem HealthKeepers Plus Program Documents - Virginia

COVID-19 Resource Links

• CD Services COVID-19 Fact Sheet
• CD Services Personal Care COVID-19 Fact Sheet
• FAQs COVID- 19 Emergency Changes
• VA CD Member Information
• VA CD Provider Information
• VA Government COVID-19
• VA Department of Health
• Guidance For Direct Service Providers, Caregivers, Parents, And People With Developmental And Behavioral Disorders CDC

Guides and FAQ's

• Virginia CCC Plus Customer Service Quick Facts
• Virginia Consumeremployer FAQ
• Virginia Overtime FAQ
• Virginia Attendant FAQ
• Employerconsumer Self Service Options
• Go Green Pay Stubs FAQ

Attendant Enrollment Information and Instructions

• Attendant Application Request Form
• Attendant Application For Tax Exemption Form
• Attendant Application Request Instructions
• Application For Tax Exemptions Instructions
• Difficulty Of Care Employee Application
• Difficulty Of Care Exclusion Information
• Difficulty Of Care Instructions
• Fair Labor Standards Act Live In Exemption
• USCIS Form I-9
• Checklist To Complete The I-9 Form
• USCIS Form I-9 Instructions
• USCIS Form I-9, Spanish (FOR REFERENCE ONLY)
• USCIS Form I-9 Instructions, Spanish (FOR REFERENCE ONLY)
• U.S. Citizenship and Immigration Services (USCIS) Form I-9 Changes
• Virginia Criminal History Record Name Search Request Form (SP 167)
• Virginia Criminal History Record Name Search Request Instructions
• Virginia DSS CPS Central Registry Release Form
• Virginia DSS CPS Central Registry Release Form Instructions
• VA-4 Attendant Tax Withholding Form
• VA-4 Attendant Tax Withholding Form Instructions
• IRS Form W-4
• W-4 Attendant Federal Tax Withholding Form Instructions

Attendant Post-Enrollment Information and Instructions

• Attendant Change Of Address Form
• Attendant Change Of Information Form
• Attendant Payment Change Form
• Attendant Payment Change Form Instructions

Payroll Forms and Information

• FIPS Codes
• Virginia CCC Plus Pay Schedule A 2021 Central VA & Tidewater
• Virginia CCC Plus Pay Schedule B 2021 Northern VA, Piedmont & Southwest

MCO Information

• Anthem Long Term Services And Supports Authorization Guide
• Anthem Frequently Asked Questions For Anthem Members And Attendants

Employer Enrollment Information and Instructions

• SS4 Employer Form Instructions
• 2678 Employer Form Instructions
• Authorized Representative Signatory Form Instructions
• Guide To An Existing EIN
• Attendant Application Request Form
• Attendant Application Request Instructions

Employer Post-Enrollment Information and Instructions

• Consumer Contact Information Change Form
• Employer Of Record Contact Info Change Form
• Notice Of Discontinued Employment
• Notice Of Discontinued Employment Instructions

Forms

• Virginia Formal Complaint Form

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