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  • Anthem Provider Dispute Resolution Form 2009

Get Anthem Provider Dispute Resolution Form 2009-2025

On Form, provided later in this section. Local Providers have one year from the date of the original explanation of benefits (EOB) or remittance advice (RA) to appeal a claims adjudication action. This policy does not apply to routine provider inquiries that Anthem resolves in a timely fashion through existing informal processes (i.e., through customer service or submission of a Claim Action Request Form). National Accounts Providers appeals time limits are based on time limits listed in the Pro.

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The appeal must be received by Anthem Blue Cross (Anthem) within 365 days from the date on the notice of the letter advising of the action.

Where can an appeal be filed? 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.

Claim payment reconsideration. This is the first step and must be completed within 60 calendar days of the date of the provider's remittance advice.

The request must be submitted within 60 calendar days of notification of claim payment or denial. The date of notification is considered to be the date on the most recent RA for the claim.

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.

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.

How to file an appeal Written: MHS Appeals, P.O. Box 441567, Indianapolis, IN 46244. Phone: MHS Member Services or MHS Appeals at 1-877-647-4848 (TTY: 1-800-743-3333) Fax: 1-866-714-7993. Email: appeals@mhsindiana.com.

We'll send you an acknowledgement letter within three business days after we get your appeal. The letter will tell you we got your appeal request. You can also ask for an appeal by calling Member Services at 1-866-408-6131 (TTY 711).

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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