Anthem Claim Dispute Form With 2 Points In Travis

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

Description

The Anthem claim dispute form with 2 points in Travis is a crucial document that facilitates the resolution of disputes between creditors and debtors. This form outlines the agreement between the two parties regarding a disputed claim, specifying the nature of the claim and the reasons for its denial by the debtor. Key features of the form include sections for both parties to provide their names and addresses, the amount being agreed upon for settlement, and clear language detailing the claims involved. Completing this form requires careful attention to the specific claims and their denial to ensure clarity and avoid future disputes. It is particularly useful for attorneys, partners, and legal assistants who handle debt-related cases, providing a structured format to negotiate and document agreements. The form assists in ensuring both parties understand their rights and obligations, minimizing the risk of miscommunication. Moreover, it serves as an essential tool for paralegals and associates involved in drafting settlement agreements, helping them to streamline the dispute resolution process effectively.

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FAQ

Anthem follows the standard of: • 90 days for participating 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.

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.

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.

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.

You need to file your appeal within 60 calendar days from the date on the coverage determination/organization determination notice (denial letter) you received.

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

Payer Name and ID 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.)

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.

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Anthem Claim Dispute Form With 2 Points In Travis