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  • Anthem Form 94044 2003

Get Anthem Form 94044 2003-2025

Ntal or Vision benefits may be available for you and/or covered Dependents. See your employer for eligibility. To apply for continuation of Medical, Dental or Vision benefits, complete and return this form to your Employer (or previous Employer in the event of termination of employment). TO BE COMPLETED BY EMPLOYER ONLY Employee Name (First, Middle Initial, Last) Employer Name Date of Hire - - STATE CONTINUATION OF COVERAGE (Applicable to employers with less than 20 employees and church and.

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Written reconsiderations To submit a written reconsideration, use a blank Claim Information/Adjustment Request 151 Form, available online at https://mediproviders.anthem.com/va > Claims > Forms. Once the form is complete, attach any necessary information and mail it to: HealthKeepers, Inc.

Your EOBs Are Available Online! Sign up for Blue Access for MembersSM (BAMSM) at bcbsil. com for convenient and confidential access to your claim information and history. Choose to opt out of receiving EOBs by mail to save time and resources.

After we complete our review of your claim, you'll receive an Explanation of Benefits (EOB) showing what we paid, and what you owe. Log in to your member account to view your claims and EOBs.

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: • 90 days for participating providers and facilities. 15 months for nonparticipating providers and facilities.

How to read an EOB How much your provider charged for services. How much of those charges your health plan covers. The amount your health plan paid. The amount you owe, including deductibles, copays or coinsurance (see definitions)

Documents you previously received with Anthem, Inc. may now reflect our new parent company name, Elevance Health; however, a very minimal number of communications should mention our parent company by name. In general, checks and other financial statements may include the Elevance Health name or logo.

Anthem is part of the Blue Cross Blue Shield group. Blue Cross Blue Shield is made up of independent companies. Anthem is one of these companies. Other Blue Cross Blue Shield brands include Highmark, Regence and CareFirst.

Information Log into Change Healthcare and navigate to the Remits tab. Apply any necessary filters and click Search. Select the check/EFT number in the “Check/EFT” column. Click Data Viewer. Click Payment Detail and select the line item. Click View EOB.

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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
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