Anthem Claim Dispute Form For Reimbursement In Pima
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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.
The corrected claim must be received within the timely filing limit due to the initial claim not being considered a clean claim. For participating and nonparticipating providers, Anthem follows the standard of 60 days from the date of payment (Explanation of Payment/Remittance Advice).
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.
Submit a separate claim for each patient. Complete the form following the instructions on the back. (You can fill the form in electronically or complete it by hand.) Print and mail the form to your local Blue Cross and Blue Shield company by December 31 of the year following the year you received service.
-Timely filing is within 180 days of the date of service or per the terms of the provider agreement. Out-of-state and emergency transportation providers have 365 days from the last date of service.
How To Submit An Anthem Claim Yourself. Typically, your doctor or provider, especially if they're in your plan, will submit the claim for you. In some cases when you visit a doctor outside your plan, you may have to do this yourself. You can access claim forms in our Forms Library.
A corrected claim is a replacement of a previously billed claim that requires a revision to coding, service dates, billed amounts or member information. Timeliness must be adhered to for proper submission of corrected claim. Corrected claim timely filing submission is 365 days from the date of initial determination.
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.
Customer Care Centers Call 888-831-2246 Option 4 and ask to speak with Dr.
For help, call us at the number listed on your ID card or 1-866-346-7198.
