Anthem Claim Dispute Form For Reimbursement In Riverside

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

Description

The Anthem claim dispute form for reimbursement in Riverside serves as a structured tool for individuals and entities seeking to address issues related to insurance claims with Anthem. This form includes sections for identifying the claim details, the parties involved, and the specific dispute at hand. It is particularly useful for legal professionals, such as attorneys and paralegals, who assist clients in resolving reimbursement disputes effectively. The form clearly outlines the requirements for submission, including necessary documentation and deadlines, helping users navigate the claims process smoothly. The form is designed to be completed with straightforward language, minimizing legal jargon to enhance accessibility for users with varying levels of legal knowledge. Additionally, it provides clear instructions for filling out the required fields to ensure compliance with Anthem’s policies. Key use cases include facilitating negotiations between insured parties and Anthem, supporting appeals for denied claims, and providing a written record for legal proceedings if necessary. Overall, this form is an essential resource for attorneys, partners, owners, associates, paralegals, and legal assistants involved in claims management.

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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.

Timely filing is when an insurance company put a time limit on claim submission. For example, if a insurance company has a 90-day timely filing limit that means you need to submit a claim within 90 days of the date of service.

Anthem follows the standard of: • 90 days for participating providers and facilities.

Original (or initial) Medi-Cal claims must be received by the California MMIS FI within six months following the month in which services were rendered. This requirement is referred to as the six-month billing limit.

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.

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.

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.

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

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Anthem Claim Dispute Form For Reimbursement In Riverside