We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • Social Forms
  • Virginia Social Forms
  • Va Anthem Form 151 2002

Get Va Anthem Form 151 2002

Claim Information/ Adjustment Request 151 Form Please Mail Form To P. O. Box 27401 Richmond VA 23279-7401 Provider Please complete all sections of this form to assist us when researching your inquiry. Insured s ID Number Claim Filed Paper as shown on Patient s ID card Claim Type Professional Patient s Name Electronic Patient s Account Number Facility Date Sent Dental Other Insurance if applicable to inquiry Claim Number Charge Please Return To Insurance Company Name Telephone Number Policy Number Effective Date Name of Referring Physician Provider s Name and Address Certification Number Dates of Service Home Other Inpatient Hospital Office Place of Treatment PLEASE DESCRIBE Outpatient Hospital Group Name or Number Reason Additional Information Attached Other Explain Overpayment Underpayment Onset Date // Check Appropriate Box Consult Date // LMP Accident Illness first symptom 837 Attachment Control Number Briefly Describe Claim Issue and Action Required For Internal Use Only Reply Date....

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the VA Anthem Form 151 online

Completing the VA Anthem Form 151 online is a straightforward process that assists in managing your claims effectively. This guide will take you through each section of the form to ensure you provide all necessary information accurately.

Follow the steps to fill out the VA Anthem Form 151 online

  1. Press the ‘Get Form’ button to access the VA Anthem Form 151 and open it in your preferred online editor.
  2. Begin by filling in the insured's ID number. This information is typically found on the patient's ID card and is essential for processing your claim.
  3. Next, indicate the claim type by selecting one of the options: Professional, Dental, Facility, or Other Insurance if applicable to your inquiry.
  4. Provide the patient’s name and account number. Ensure spelling is accurate to avoid any processing delays.
  5. Fill in the claim number associated with the service provided, as well as the charge amount, ensuring that all numbers are entered correctly.
  6. In the section labeled 'Reason', briefly describe the nature of your claim issue. This helps to clarify your request.
  7. Enter the dates of service in the appropriate fields. Make sure to provide accurate dates to reflect the treatment or service rendered.
  8. Complete the additional fields regarding the referring physician, provider's name and address, and insurance company details, including policy number and effective date.
  9. If applicable, check the appropriate box regarding overpayment or underpayment and provide the relevant details.
  10. Once you have filled out all sections, review your information for accuracy. You can then save your changes, download, print, or share the completed form as needed.

Take action today by completing your VA Anthem Form 151 online.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Related content

Anthem Health Plans of Virginia, Inc. trades as...
When you submit a Claims Information and Adjustment. Request Form (151), please be sure to...
Learn more
Anthem PPO Plan PPO Network University of...
by APPO Plan — This Benefit Booklet gives you a description of your benefits while you...
Learn more
LTX-500
Informazioni per gli utenti sullo smaltimento delle apparecchiature e batterie obsolete...
Learn more

Related links form

CA Landscape Turf Replacement Program - City Of San Diego 2013 CA Lease Agreement between the City of Covina Tenant and WLM-CCC 2016 CA LIHEAP Application Instructions 2017 CA Liquidambar Removal Permit Application - Sunnyvale

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

Yes, Anthem Blue and Anthem Blue Cross are often used interchangeably to refer to the same insurance provider. Anthem Blue Cross operates under the Anthem brand and provides various health insurance products. If you're filing claims, remember to leverage the VA Anthem Form 151 for a smoother experience.

Several lawsuits have been filed against Anthem Blue Cross regarding issues such as claim denials and improper billing practices. These legal actions often stem from concerns where policyholders feel their claims were unjustly denied or delayed. If you're dealing with a claim issue, using the VA Anthem Form 151 can aid in your appeal and strengthen your case.

The timely filing limit for an Anthem appeal is typically 180 days from the date of the original claim denial. However, it's important to review your specific policy as individual plans may have variations. To ensure you have all the necessary documentation, consider using the VA Anthem Form 151 for your appeal submission.

Yes, Anthem is part of the Virginia Medicaid program, operating as Anthem HealthKeepers. This plan plays a crucial role in providing necessary healthcare services to eligible Virginians, ensuring access to treatments and preventive services. Understanding your options within this Medicaid plan can empower you to make informed healthcare decisions. For reference and assistance, utilize the VA Anthem Form 151.

Anthem operates both Medicare and Medicaid programs, but Anthem HealthKeepers specifically serves the Medicaid population in Virginia. Medicare generally provides health coverage for seniors and younger individuals with disabilities, while Medicaid assists low-income individuals and families. If you’re navigating these options, it’s essential to understand which program suits your needs best. The VA Anthem Form 151 can offer guidance in these matters.

Anthem HealthKeepers is a particular branch of Anthem, focusing specifically on Medicaid services in Virginia. While they share the Anthem brand, HealthKeepers operates within the framework of Medicaid, catering to a distinct group of individuals with specific healthcare needs. If you have questions about your coverage or benefits, the VA Anthem Form 151 can help clarify details.

Virginia's Medicaid program is commonly referred to as 'Medicaid Virginia.' This program provides essential medical services to eligible residents, helping to cover healthcare costs for low-income individuals and families. By offering a variety of plans, including the Anthem HealthKeepers, Virginia ensures that all residents have access to needed healthcare services. If you need assistance, the VA Anthem Form 151 can provide useful resources.

Yes, Anthem HealthKeepers is part of the Virginia Medicaid plan. It provides comprehensive healthcare services to eligible individuals, ensuring access to a wide range of medical care. By enrolling in this plan, members can benefit from various health services, including preventive care, hospital visits, and prescription drugs. If you have further questions about enrollment, the VA Anthem Form 151 can guide you through the process.

The timely filing limit refers to the period within which a claim must be submitted to an insurance provider for payment consideration. Typically, insurance companies have specific guidelines that dictate this timeframe, varying from 90 days to 18 months. For submitting claims efficiently, using the VA Anthem Form 151 can help you meet these deadlines.

The timely filing limit for Blue Cross Blue Shield (BCBS) corrected claims is typically within 12 months of the original claim date. This means you must submit any corrections within this time frame to ensure proper processing. Utilizing the VA Anthem Form 151 for corrections can help streamline your submission and ensure compliance.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get VA Anthem Form 151
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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
VA Anthem Form 151
This form is available in several versions.
Select the version you need from the drop-down list below.
2014 VA Anthem Form 151
Select form
  • 2014 VA Anthem Form 151
  • 2002 VA Anthem Form 151
Select form