Anthem Claim Dispute Form With Decimals In Virginia
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FAQ
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.
Corrected claims must be received within 12 months of Explanation of Payment (EOP). Appeal deadlines: Claim payment reconsideration must be filed within 12 months of the EOP. Claim payment appeals must be filed within 15 months of service or 180 days from the reconsideration decision.
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.
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.
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.
You can also fax to 855-516-1083. Please be sure to mark "EXPEDITED" on the form before faxing.
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.
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.
Anthem and Blue Cross Blue Shield are related, but they are not the same company. While they are both top health insurance providers in the USA, the big difference is that Blue Cross Blue Shield is the umbrella that is made up of several independent companies, and one of these smaller companies is Anthem.
