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3500 Civil Procedure Forms
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Agreement for Accord and Satisfaction of a Disputed Claim

Anthem Claim Dispute Form With Decimals In Bexar

Q: What is the timely filing limit for Anthem Blue Cross of California?

Anthem follows the standard of: 90 days for participating providers and facilities. 15 months for nonparticipating providers and facilities.

Category:

Civil Procedure - Accord and Satisfaction

State:

Multi-State

County:

Bexar

Control #:

US-00435BG

Format:

Instant download

Description

The Anthem claim dispute form with decimals in Bexar serves as a key document for formalizing an agreement between a creditor and a debtor regarding a disputed claim. This form outlines the nature of the claims, including specific amounts owed and the reasons behind the dispute. Key features include sections for both parties to clearly state their identities, the specific claims involved, and the terms of the discharge from further claims once the agreement is executed. Users are instructed to fill in the necessary information such as dates, names, addresses, and claim details in a clear and concise manner. This form is particularly useful for attorneys, partners, owners, associates, paralegals, and legal assistants who manage debt disputes or negotiate settlements. It ensures that both parties have a mutual understanding and legal protection by formally documenting the resolution of their claims. Additionally, it facilitates the process of settling disputes without going to court, saving both time and resources. The straightforward layout encourages efficient completion and filing, making it accessible for users with varying legal expertise.

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FAQ

You have the right to voice your dissatisfaction with any aspect of Anthem' services for investigation and resolution by: Writing your grievance. Completing the online GRIEVANCE FORM. Calling our Customer Care Center at 800-407-4627 (TTY 711) Monday to Friday, 7 a.m. to 7 p.m. Pacific time.

Members have up to 180 calendar days from the date of an incident or dispute, or from the date the member receives a denial letter, to submit a grievance or appeal to Anthem Blue Cross.

How to file a grievance or appeal. You may submit a grievance or an appeal online, by phone, by mail, or in person. Please review your Member Handbook (Evidence of Coverage) for guidelines on how to file a grievance or an appeal. Los Angeles: (800) 605-2556 (TTY: 711), 8 a.m. to 6 p.m., Monday through Friday.

When complete, please mail to: Attn: Grievance and Appeals Department, Anthem Blue Cross, P.O. Box 60007, Los Angeles, CA 90060-0007. For claim disputes, please use the Provider Dispute Resolution form. This information is part of the permanent record. Write clearly and legibly.

Anthem follows the standard of: • 90 days for participating providers and facilities. 15 months for nonparticipating providers and facilities.

Original (or initial) Medi-Cal claims must be received by the California MMIS FI within six months following the month in which services were rendered. This requirement is referred to as the six-month billing limit.

Timely filing is when an insurance company put a time limit on claim submission. For example, if a insurance company has a 90-day timely filing limit that means you need to submit a claim within 90 days of the date of service.

Claim forms are available by logging into the member website at blueshieldca or by contacting the benefit administrator. Please submit your claim form and medical records within one year of the service date.

Your payer name is Anthem BC California and the payer ID is 47198 (If you use a billing company or clearinghouse for your EDI transmissions, please work with them on which payer ID they want you to use.) Questions? We're here to help.

Customer Care Centers Call 888-831-2246 Option 4 and ask to speak with Dr.