Anthem Claim Dispute Form For Providers In Fairfax
Description
Get your form ready online
Our built-in tools help you complete, sign, share, and store your documents in one place.
Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Looking for another form?
Form popularity
FAQ
Written reconsiderations To submit a written reconsideration, use a blank Claim Information/Adjustment Request 151 Form, available online at > Claims > Forms. Once the form is complete, attach any necessary information and mail it to: HealthKeepers, Inc.
Shopping Assistance Individual & Family Plans (under age 65): 1-844-290-7588. Medicare Supplement and Medicare Advantage Plans: 4/1 – 9/30: Mon-Fri, 8 a.m. to 8 p.m. Medicare Part D Plans: 4/1 – 9/30: Mon-Fri, 8 a.m. to 8 p.m. Employer Plan: Contact your broker or consultant to learn more about Anthem plans.
If you'd like to update your credentials to include ABA or an autism spectrum disorder-related specialty, contact your Provider Relations representative, or call Provider Services at 1-800-450-8753.
A complaint (or grievance) – when you have a problem with Anthem or a provider, or with the healthcare or treatment you got from a provider. An appeal – when you don't agree with Anthem's decision to change your services or to not cover them.
The appeal must be received by Anthem Blue Cross (Anthem) within 365 days from the date on the notice of the letter advising of the action.
If you have any questions about our plan benefits, procedures and other topics, call Provider Services at (800) 468-9935 (TTY 711), 6 a.m. to p.m., Monday through Friday. To notify us of hospital admissions, call Provider Services at 800-468-9935 (TTY 711).
Non-participating providers: Call the number on the back of the member's ID card or call 800-676-BLUE (2583) to reach Provider Services. You can also use chat or secure messaging directly in Availity.
Contact your agent for personalized help. You may also call Anthem Blue Cross at (833) 933-0806 or Covered California at (800) 300-1506.
In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc. trades as Anthem HealthKeepers providing HMO coverage, and their service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123.
Customer Care Centers Call 888-831-2246 Option 4 and ask to speak with Dr.
