Anthem Claim Dispute Form With Email In Bronx

State:
Multi-State
County:
Bronx
Control #:
US-00435BG
Format:
Word; 
Rich Text
Instant download

Description

The Anthem claim dispute form with email in Bronx is designed for users seeking to resolve disputes related to insurance claims efficiently. This form serves as an essential tool for attorneys, partners, owners, associates, paralegals, and legal assistants involved in handling Anthem insurance claims. Key features include sections for detailing the nature of the claim, reasons for dispute, and the specifics of the agreement between the creditor and debtor. Users are guided to fill in the required information concisely, ensuring clarity in communication. Filling and editing instructions advise users to ensure that all parties understand the terms and conditions outlined in the form. The utility of this form extends to situations where an agreement on a disputed claim is necessary, facilitating the settlement process while protecting the legal rights of all parties involved. By utilizing this form, legal professionals can streamline their documentation process and bolster their case management strategies.

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FAQ

Please fax to 1-855-516-1083. You may ask us to rush your appeal if your health needs it. We'll let you know we got your appeal within 24 hours from the time we received it.

You can also call a representative at 800-300-8181 (TTY 711), Monday through Friday from 8 a.m. to 8 p.m. and on Saturday from 9 a.m. to 5 p.m. Eastern time.

You can also fax to 855-516-1083. Please be sure to mark "EXPEDITED" on the form before faxing.

After you fill out the form, Mail/Fax/deliver your request for a hearing within 33 days of the date of the notice you are appealing. Mail: FSSA Document Center PO Box 1810 Marion, Indiana 46952 Fax: 1-800-403-0864 Visit your local DFR/Medicaid Office.

Yes. We will retain the Blue Cross and Blue Shield and Blue Cross in our name. Anthem Blue Cross and Blue Shield and Anthem Blue Cross are our local health insurance companies in our 14 Blue-licensed markets and will continue to be our local health plan brands in those states, which now includes New York.

One redetermination form can be submitted for multiple claims only for denials by the Unified Program Integrity Contractor or Medical Review probe reviews. Fax request to 1-888-541-3829.

Fax: 800-964-3627. Phone: 800-450-8753.

File the appeal within ten (10) days from the date your "Determination of Eligibility" was sent by one of these methods: Mail the appeal to 10 North Senate Avenue, Indianapolis, IN 46204; Fax the appeal to (317) 233-6888; Deliver the appeal in person to the Department at 10 N.

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Anthem Claim Dispute Form With Email In Bronx