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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.

Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.

If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
When complete, please mail to: Attn: Grievance and Appeals Department, Anthem Blue Cross, P.O. Box 60007, Los Angeles, CA 90060-0007. For claim disputes, please use the Provider Dispute Resolution form. This information is part of the permanent record. Write clearly and legibly.
Anthem Blue Cross is the trade name of In California: Blue Cross of California, Anthem Blue Cross Partnership Plan, Anthem BC Health Insurance Company and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.
Effective Date: January 1, 2024 Plan NameSingle (1)Two-Party (2) Anthem Blue Cross Del Norte EPO $1,240.19 $2,480.37 Anthem Blue Cross Select HMO $944.08 $1,888.16 Anthem Blue Cross Traditional HMO $1,221.90 $2,443.80 Blue Shield Access+ EPO $910.34 $1,820.6815 more rows •
For help, call us at the number listed on your ID card or 1-866-346-7198.
Phone: 800-977-2273 (TTY 711)
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
Case Management for Anthem Blue Cross Cal MediConnect Plan Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.
You can also call a representative at 800-300-8181 (TTY 711), Monday through Friday from 8 a.m. to 8 p.m. and on Saturday from 9 a.m. to 5 p.m. Eastern time.
How to Find Timely Filing Limits With Insurance Insurance CompanyTimely Filing Limit (From the date of service) Anthem BCBS Ohio, Kentucky, Indiana, Wisconsin 90 Days Wellmark BCBS Iowa and South Dakota 180 Days BCBS Alabama 2 Years BCBS Arkansas 180 Days28 more rows