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  • Anthem 2 50 Existing Small Group Addition Form

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F delay, please answer all questions and be sure to sign and date your application. Group No. 1a. Medical Coverage please ask your employer which Medical plans are available before checking your selection: o Basic PPO** o Saver PPO** o PPO $35 Copay GenRx** o PPO $45 Copay GenRx** o PPO $30 Copay* o PPO $40 Copay* o Lumenos HSA 1500** o Lumenos HSA 3000** o Power HealthFund 750** o Solution 5000 PPO** If HMO, be sure to provide physician number in section 3 o Lumenos HIA Plus.

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A medical claim is a bill that healthcare providers submit to a patient's insurance provider. This bill contains unique medical codes detailing the care administered during a patient visit. The medical codes describe any service that a provider used to render care, including: A diagnosis.

DRG CodeDRG DescriptionSurgical Category066INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC)Non Surgical065INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR COMORBIDITY (CC) OR TPA IN 24 HOURSNon Surgical1 more row

Anthem will allow separate reimbursement for E&Ms performed on the same day of a major surgery (90-day global period) or minor surgery (0-day or 10-day global period) when billed with a modifier 25.

Denial codes are codes assigned by health care insurance companies to faulty insurance claims. They include reason and remark codes that outline reasons for not covering patients' treatment costs. You can refer to these codes to resolve denials and resubmit claims.

Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company (CIC).

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

Anthem allows reimbursement of procedures eligible for surgical teams when billed with Modifier 66 unless provider, state, federal or CMS contracts and/or requirements indicate otherwise.

Insurance codes are used by your health plan to make decisions about your prior authorization requests and claims, and to determine how much to pay your healthcare providers. Typically, you will see these codes on your Explanation of Benefits and medical bills.

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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