Anthem Claim Dispute Form With Email In Virginia
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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
A number, code, or other value that indicates the services provided on this claim have been authorized by the payee or other service organization, or that a referral for services has been approved. (Also called Prior Authorization or Referral Number).
Call Member Services at 800-901-0020 (TTY 711).
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.
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.
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.
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.
To check the status of a prior authorization request or decision for a particular plan member, or to submit a clinical appeal, providers will access our Interactive Care Reviewer (ICR) tool via Availity Essentials.
For all other precertification requests (including all elective inpatient or outpatient services), please fax to: 1-800-964-3627.
Welcome to the Anthem HealthKeepers Plus plan. Anthem HealthKeepers Plus is one of the largest managed care plans providing Medicaid coverage in the state of Virginia.
Anthem Inc., a separate company from Premera that is also an independent licensee of the Blue Cross Blue Shield Association, recently suffered a cyber-attack which has been widely reported in the media.
