Anthem Claim Dispute Form For California In Middlesex

State:
Multi-State
County:
Middlesex
Control #:
US-00435BG
Format:
Word; 
Rich Text
Instant download

Description

The Anthem claim dispute form for California in Middlesex is designed to facilitate the resolution of disputes between creditors and debtors regarding claims and demands. This form outlines the agreement made on a specific date between the creditor and debtor, detailing the payment amount and the nature of claims being released. Key features include sections for entering personal information, claim details, and the specific reasons claims are being denied. The form serves various legal professionals, including attorneys, partners, owners, associates, paralegals, and legal assistants, enabling them to manage disputed claims efficiently. Filling instructions emphasize clear communication, requiring both parties to explicitly state their claims and denials. Users should ensure all sections are completed accurately for the form to be legally binding. This form is particularly useful in situations where parties seek to avoid further litigation by agreeing to settle claims amicably. It offers a structured approach to resolving disputes, ultimately saving time and costs associated with legal proceedings.

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FAQ

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 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.

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.

You may submit a grievance or an appeal online, by phone, by mail, or in person. Please review your Member Handbook (Evidence of Coverage) for guidelines on how to file a grievance or an appeal. Los Angeles: (800) 605-2556 (TTY: 711), 8 a.m. to 6 p.m., Monday through Friday.

Blue Shield of California is a Registered® mark of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans. Blue Shield of California and Mylifepath are service marks of Blue Shield of California.

How to file a grievance or appeal. You may submit a grievance or an appeal online, by phone, by mail, or in person. Please review your Member Handbook (Evidence of Coverage) for guidelines on how to file a grievance or an appeal. Los Angeles: (800) 605-2556 (TTY: 711), 8 a.m. to 6 p.m., Monday through Friday.

Contact your agent for personalized help. You may also call Anthem Blue Cross at (833) 933-0806 or Covered California at (800) 300-1506.

With the PPO, you can use any of the BCBS providers in all 50 states. They may not be directly contracted with the BS of CA, but as long as they participate with the BCBS in the state you see a provider in, they will file claims with that plan. Benefits would be covered at the in-network rates given that's the case.

Blue Shield sold Care1st Arizona to WellCare in 2017. Care1st California was renamed Blue Shield of California Promise Health Plan in 2019.

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Anthem Claim Dispute Form For California In Middlesex