Anthem Claim Dispute Form For Providers In Franklin
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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.
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FAQ
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.
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.
Send this claim to: Blue Shield of California, P.O. Box 272540, Chico, CA, 95927-2540.
Anthem will consider reimbursement for the initial claim, when received and accepted within timely filing requirements, in compliance with federal, and/or state mandates. Anthem follows the standard of: • 90 days for participating providers and facilities.
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.
The Anthem Process is our unique way of working, which combines years of experience across specialties and the latest diagnostics with the support and accountability you need to make long-lasting change.
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.
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.
Anthem follows the standard of: • 90 days for participating providers and facilities. 15 months for nonparticipating providers and facilities.
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.
