Anthem Claim Dispute Form With Provider In San Jose

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

Description

The Anthem claim dispute form with provider in San Jose is a legal document designed to facilitate the resolution of disputes between healthcare providers and Anthem regarding claims. This form is particularly useful for attorneys, partners, owners, associates, paralegals, and legal assistants involved in managing healthcare disputes. Key features include sections for detailing the nature of the claim, the specific amounts disputed, and any relevant information that supports the claim. Users should fill out the document clearly, ensuring all sections are completed with accurate information to avoid delays. It is advisable to provide a concise description of the claim and the rationale behind any disputes. Once filled out, both parties must sign the document to validate the agreement. The form aids in establishing a formal understanding between the provider and Anthem, potentially expediting the resolution process and minimizing further legal action. Overall, it serves as an essential tool for ensuring compliance and clarity in healthcare claims disputes in the San Jose area.

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FAQ

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.

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.

Log into Availity Essentials. Select Claims & Payments from the navigation menu, then choose Claim Status. Search and locate the claim using the Member or Claim Number options. On the Claim Status results page, select Dispute Claim (if offered and applicable)

Send this claim to: Blue Shield of California, P.O. Box 272540, Chico, CA, 95927-2540.

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.

Anthem follows the standard of: • 180 days for participating providers and facilities. 210 days for nonparticipating providers and facilities. Timely filing is determined by subtracting the date of service from the date we receive the claim and comparing the number of days to the applicable federal or state mandate.

Customer Care Centers Call 888-831-2246 Option 4 and ask to speak with Dr.

Simply put, you can appeal if you think there is a logical and acceptable reason why the claim was false. It would probably be denied if there was no way to submit the claim within the time limit However, if you have a valid reason, this denial could get overturned, and your claim might be accepted.

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Anthem Claim Dispute Form With Provider In San Jose