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  • Anthem Provider Dispute Resolution Request

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Anthem Blue Cross and Blue Shield Partnership Plan, Inc. State Sponsored Business Provider Dispute Resolution Request Page 1 of 2 Submission of this form constitutes agreement not to bill the patient.

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Anthem follows the standard of: • For participating providers — within the 180 day timely filing period. For nonparticipating providers — within the 365 day timely filing period.

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.

A provider dispute is a written notice from the non-participating provider to Health Net that: Challenges, appeals or requests reconsideration of a claim (including a bundled group of similar claims) that has been denied, adjusted or contested. Challenges a request for reimbursement for an overpayment of a claim.

If you need assistance, please call Provider Services at 844-396-2330. You can call Monday through Friday from 8 a.m. to 5 p.m. PT.

Blue Shield of California healthcare providers can file disputes by printing, filling out, and mailing the appropriate provider dispute resolution form to the right address. Find forms and mailing addresses below. A dispute submitted in writing must contain the following information: The provider's name.

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.

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

Call Member Services at 1-855-817-5785 (TTY: 711) Monday through Friday from 8 a.m. to 8 p.m. This call is free. Fax your written appeal to 1-888-458-1406.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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