Get Va Anthem 110845 2013
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How to fill out the VA Anthem 110845 online
The VA Anthem 110845 form is essential for users seeking to request a refund for overpayments made by their practice. This guide provides clear, step-by-step instructions on how to accurately fill out this form online, ensuring that users can efficiently manage their refund requests.
Follow the steps to complete the VA Anthem 110845 form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by checking the appropriate box to indicate whether you are sending a check issued by your practice to Anthem Blue Cross and Blue Shield, or if you are returning a check issued by Anthem.
- Fill in the refund information section, providing the date, patient name, provider number, member identification number, provider name, patient account number, provider address, city, state, zip, claim number, date(s) of service, provider phone number, refund check amount, provider contact name, and attached check number if applicable.
- Indicate the reason for the refund by checking the appropriate box. If necessary, provide details for the 'Other' category.
- If you are submitting this form for Anthem’s review, leave the 'Refund Action Taken' section blank as it is intended for Anthem's use only.
- Once all fields are accurately filled out, review the information for accuracy and completeness.
- After confirming the information is correct, you can save changes, download, print, or share the completed form as needed.
Complete your VA Anthem 110845 form online today to ensure a smooth refund process.
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Timely filing for VA claims means the period during which you must submit your claims for VA Anthem 110845 to receive benefits. Generally, you should file within one year of the service date to avoid denial. Following the correct protocol is essential for a smooth claims process, and delays can impact your access to necessary care. Explore US Legal Forms to access tools and templates that can simplify this process.
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