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Patient Claim Form CLAIM CONTROL NUMBER FOR OFFICE USE ONLY MEMBER INFORMATION PATIENT INFORMATION NAME I.D. NUMBER LAST FIRST DATE OF BIRTH MO MIDDLE SEX DAY RELATIONSHIP TO MEMBER M YR F SELF SPOUSE.

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How to fill out the Anthem Blue Cross Claims Form online

Filing a claim with Anthem Blue Cross is essential for receiving benefits for covered health services. This guide provides a clear, step-by-step approach to completing the Anthem Blue Cross Claims Form online, ensuring a smooth submission process.

Follow the steps to fill out the Anthem Blue Cross Claims Form effectively

  1. Press the ‘Get Form’ button to access the Anthem Blue Cross Claims Form and open it in your editor.
  2. Begin by filling out the member information section. Include the member's name, ID number, relationship to the member, and daytime phone number. If applicable, provide details regarding Medicare coverage.
  3. In the patient information section, enter the patient's name, date of birth, sex, occupation, and contact details. Make sure to state if the patient is covered by Medicare.
  4. Complete the section regarding any other insurance coverage the patient may have, as well as information about the other parent's details, if the claim is for a dependent child.
  5. Describe the patient's illness or injury, including the date of occurrence and relevant details about employment, if applicable.
  6. For prescription drugs, list only those requiring a written prescription and fill in details such as the purchase date, drug name, diagnosis, and cost.
  7. Upon completing all sections, ensure all bills are itemized and include the necessary details to avoid processing delays.
  8. Finally, review the completed claim form, sign where required, and submit it along with all attached documentation to the address noted on the Anthem Blue Cross ID card.

Complete your claims form online today to ensure timely processing of your health care claims.

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Contact support

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

By Phone: Call the number on the back of the member's ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative.

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 will consider reimbursement for the initial claim, when received and accepted within timely filing requirements, in compliance with federal, and/or state mandates. Anthem follows the standard of: • 180 days for participating providers and facilities. 210 days for nonparticipating providers and facilities.

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.

Contact your agent for personalized help. You may also call Anthem Blue Cross at (833) 933-0806 or Covered California at (800) 300-1506.

How To Submit An Anthem Claim Yourself Make sure the claim form from your benefits plan includes all required information, especially procedure codes (you can receive these from your doctor's office). If you're filling the form out by hand, write legibly. File your paperwork promptly and within the time limit.

In California Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.

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