Anthem Claim Dispute Form For California In Phoenix

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

Description

The Anthem claim dispute form for California in Phoenix serves as a critical tool for parties seeking resolution in disputes related to health insurance claims. This form allows users to formally present their grievances to Anthem, detailing the nature of the dispute and facilitating a structured response. Key features of the form include sections for identifying the claim, outlining the reasons for the dispute, and a space for both the claimant and the insurer to sign, indicating their acknowledgment of the dispute. Filling out the form requires clear, concise information regarding the dispute, including specific details relevant to the claim to ensure a complete understanding of the issue at hand. Legal professionals such as attorneys, paralegals, and legal assistants can effectively use this form in their practice to assist clients with disputes against Anthem. The form is also beneficial for partners and owners in healthcare firms who may need to address disputes on behalf of their clients. In editing the form, it is essential to maintain accuracy in the details provided and to follow procedural guidelines to ensure the claim is processed correctly. Ultimately, the Anthem claim dispute form aids in promoting clear communication and effective resolution in claim disputes.

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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.

Effective January 1, 2024, Anthem Blue Cross (Anthem) will exit 14 counties listed here: Alameda, Butte, Colusa, Contra, Costa Glenn, Mariposa, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, and Yuba.

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.

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.

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.

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.

Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.

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.

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Anthem Claim Dispute Form For California In Phoenix