Anthem Client Reporting Request Form

Please complete the following fields for each client requesting reporting.

* Required

INSTRUCTIONS AND DELIVERY TIMING

• Submit one form per client.
• Monthly reports will be delivered on the 15th business day for the prior month.
• Client groups need a minimum of one full calendar month of 30 or more members enrolled in Lark to receive a monthly report, regardless of when the reporting is requested.
• Aggregate reports for all groups will be provided when there are 30 or more members enrolled.
• Client groups need a full calendar quarter of 30 or more members enrolled to receive a quarterly report, regardless of when the report is requested, and will be delivered by calendar quarter on the 15th business day of the month following the quarter end.
• All reports will be delivered in PDF format.
• A Lark account manager will reach out within 5 business days to schedule a brief, one-time verification meeting. A request must be received by the first business day of the month and verification must occur by the last business day of month prior to the first report being delivered. For example, to receive the March report (delivered in April), you must submit the request no later than March 1 and verify no later than March 31. Your request is not considered complete until verified.
• Lark’s account management team is available for meetings to address reporting questions (accountservices@lark.com).