Anthem Claim Dispute Form With 2 Points In Riverside

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

Description

The Anthem claim dispute form with 2 points in Riverside is designed to facilitate agreements between a creditor and a debtor regarding disputed claims. This form serves the purpose of outlining the specifics of a dispute and the terms of resolution between the involved parties. Key features include a section for detailing the claim or demand, the reasons for denial from the debtor, and a space for both parties to sign and date the agreement. Filling out this form requires clear and precise information, including the names and addresses of both parties and the amount involved in the dispute. It is crucial that the entries are completed carefully to ensure all details are accurately captured and legally binding. The form is particularly useful for attorneys, partners, owners, associates, paralegals, and legal assistants in managing and resolving disputes efficiently. Legal professionals can utilize this form to negotiate settlements on behalf of clients, ensuring that both parties acknowledge and agree upon the terms of the dispute resolution. Additionally, this form acts as a legal safeguard for both parties, protecting the creditor from future claims and allowing the debtor to assertively challenge claims they dispute.

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FAQ

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.

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

Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.

Send this claim to: Blue Shield of California, P.O. Box 272540, Chico, CA, 95927-2540.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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.

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.

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.

With the PPO, you can use any of the BCBS providers in all 50 states. They may not be directly contracted with the BS of CA, but as long as they participate with the BCBS in the state you see a provider in, they will file claims with that plan. Benefits would be covered at the in-network rates given that's the case.

Blue Shield sold Care1st Arizona to WellCare in 2017. Care1st California was renamed Blue Shield of California Promise Health Plan in 2019.

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Anthem Claim Dispute Form With 2 Points In Riverside