The parties may agree to a different performance. This is called an accord. When the accord is performed, this is called an accord and satisfaction. The original obligation is discharged. In order for there to be an accord and satisfaction, there must be a bona fide dispute; an agreement to settle the dispute; and the performance of the agreement. An example would be settlement of a lawsuit for breach of contract. The parties might settle for less than the amount called for under the contract.
Anthem Claim Dispute Form For Experian In Fairfax
State:
Multi-State
County:
Fairfax
Control #:
US-00435BG
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
Claim forms are available by logging into the member website at blueshieldca or by contacting the benefit administrator. Please submit your claim form and medical records within one year of the service date.
If a dispute involves a lack of a decision, it must be submitted within 365 days, or the time specified in the provider's contract, whichever is greater, after the time for contesting or denying a claim has expired.
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.
By mail: You can dispute without a credit report by writing to Experian, P.O. Box 4500, Allen, TX 75013. (Printing out Dispute by Mail instructions can streamline the process; you can also scan the completed form and submit it electronically to Experian/upload).
Important Note: You must submit your appeal within 180 days of the date on the Adverse Benefit Determination or denial letter.
Anthem follows the standard of: • 90 days for participating providers and facilities. 15 months for nonparticipating providers and facilities.
If you think we have made a mistake in denying your medical service, or if you don't agree with our decision, you can ask for an appeal. You must do this within 60 calendar days from the date on the Notice of Action sent to you. We will resolve your concerns within 30 days of receiving your complaint.
Timely filing is when an insurance company put a time limit on claim submission. For example, if a insurance company has a 90-day timely filing limit that means you need to submit a claim within 90 days of the date of service.
You can submit your documents through the Experian Dispute Center or by mail. (If you're disputing by mail, be sure to mail copies of your materials and keep all original documents for your records; you'll also need to send a copy of your government-issued ID.)
