Anthem Claim Dispute Form For Providers In King
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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
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We protect your documents and personal data by following strict security and privacy standards.
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You can also fax to 855-516-1083. Please be sure to mark "EXPEDITED" on the form before faxing.
One redetermination form can be submitted for multiple claims only for denials by the Unified Program Integrity Contractor or Medical Review probe reviews. Fax request to 1-888-541-3829.
Please fax to 1-855-516-1083. You may ask us to rush your appeal if your health needs it. We'll let you know we got your appeal within 24 hours from the time we received it.
After you fill out the form, Mail/Fax/deliver your request for a hearing within 33 days of the date of the notice you are appealing. Mail: FSSA Document Center PO Box 1810 Marion, Indiana 46952 Fax: 1-800-403-0864 Visit your local DFR/Medicaid Office.
File the appeal within ten (10) days from the date your "Determination of Eligibility" was sent by one of these methods: Mail the appeal to 10 North Senate Avenue, Indianapolis, IN 46204; Fax the appeal to (317) 233-6888; Deliver the appeal in person to the Department at 10 N.
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.
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.
Professional Claims Submission Addresses ARKANSAS Arkansas BC & BS P.O. Box 2181 Little Rock, AR 72203 CALIFORNIA Anthem BC of California P.O. Box 60007 Los Angeles, CA 90060 CONNECTICUT Anthem BC BS of Connecticut P.O. Box 533 North Haven, CT 06473 DELAWARE HighMark P.O. Box 8830 800 Delaware Avenue Wilmington, DE 1989917 more rows
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.
Non-participating providers: Call the number on the back of the member's ID card or call 800-676-BLUE (2583) to reach Provider Services. You can also use chat or secure messaging directly in Availity.
