Anthem Claim Dispute Form With Decimals In Montgomery

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

Description

The Anthem claim dispute form with decimals in Montgomery is designed to facilitate the resolution of disputes between creditors and debtors. This form outlines the agreement made between two parties, specifying the date, parties involved, and addresses. It includes a section for the creditor to outline the claims being released in exchange for a specified sum of money, clearly detailing the nature and specific source of the claim. Additionally, the debtor can provide reasons for denying the claims, ensuring clarity and mutual understanding. This form is crucial for attorneys, partners, owners, associates, paralegals, and legal assistants who handle financial disputes, as it allows for the documentation of negotiations and agreements in a legally binding manner. Proper filling out of this form helps prevent future misunderstandings. Users are instructed to ensure all sections are completed accurately, and witnesses may be required depending on jurisdiction. The use of clear language and structured sections simplifies the process, making it accessible even for those with limited legal experience.

Form popularity

FAQ

Anthem has the best health insurance for most New Yorkers. Anthem has a rating of 4 out of 5 stars from HealthCare, which is among the best in the state. These ratings measure factors like customer satisfaction, quality of care and plan management. And most people in New York can get an Anthem plan.

BCBS Companies STATE/TERRITORYAVAILABLE COMPANIES New Mexico Blue Cross and Blue Shield of New Mexico New York Anthem Blue Cross Blue Shield Highmark Blue Cross Blue Shield of Western New York Highmark Blue Shield of Northeastern New York Excellus BlueCross BlueShield50 more rows

Services provided by Anthem HealthChoice HMO, Inc., and/or Anthem HealthChoice Assurance, Inc., Independent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State.

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.

Services provided by Anthem HealthChoice HMO, Inc., and/or Anthem HealthChoice Assurance, Inc., Independent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State.

What states are covered by Anthem Insurance? Anthem, Inc. serves members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin; and specialty plan members in other states.

To use the Appeals application, the Availity administrator must assign the Claim Status role for the user. The Disputes and Appeals functionality will support Appeals, Reconsiderations and Rework requests for providers. The Disputes and Appeals functionality is accessible from the Claim Status transaction.

You can also fax to 855-516-1083. Please be sure to mark "EXPEDITED" on the form before faxing.

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.

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Anthem Claim Dispute Form With Decimals In Montgomery