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  • Member Social Security Number Exception Request Form - Anthem

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Fits. There are federal rules that determine whether Medicare or the other GHP insurance pays first. Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA), a federal law effective January 1, 2009, requires insurers of fully insured/self insured group health insurance plans and third-party administrators report specific information about Medicare beneficiaries who have other group coverage. This reporting is to assist CMS and other health insurance plans to properly coordi.

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Select Claim Status Inquiry from the drop-down menu. Submit an inquiry and review the Claims Status Detail page. If the claim is denied or final, there will be an option to dispute the claim. Select Dispute the Claim to begin this process.

What do I include with my appeal? If your appeal is about a Part D drug: Your completed Redetermination Request Form. Your name, address and member ID number. Your reasons for appealing. Any information or evidence (documents, medical records) to support your appeal.

An appeal must be filed within 60 calendar days from the date on our first letter that notifies you that services are being denied, limited, reduced, delayed or stopped.

Claim payment reconsideration. This is the first step and must be completed within 60 calendar days of the date of the provider's remittance advice.

How to find your 1095-A online Log in to your HealthCare.gov account. Under "Your Existing Applications," select your 2022 application — not your 2023 application. Select “Tax Forms” from the menu on the left. Download all 1095-As shown on the screen.

Select Claims from the left-hand navigation menu. Select Appeal Claim from the left-hand navigation menu, and then Go to Availity. If you are navigating to the claims submission tool from .Availity.com: Click on Log in and enter your Availity ID and password.

You can also file a grievance by: Calling Member Services at 844-912-0938 (TTY 711). Logging into the secure member portal or the mobile app and finding Grievances under Support. Printing the form and emailing it to ohioga@anthem.com or faxing it to us at 866-587-3316.

Anthem Blue Cross will not use or share Social Security numbers or personal information with anyone outside the company except when permitted or required by federal and state law. Anthem Blue Cross Associates must only access Social Security numbers or personal information as required by their job duties.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232