Anthem Claim Dispute Form For Reimbursement In Santa Clara
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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.
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.
You need to file your appeal within 60 calendar days from the date on the coverage determination/organization determination notice (denial letter) you received.
Case Management for Anthem Blue Cross Cal MediConnect Plan Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.
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.
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.
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.
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.
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.
Blue Shield sold Care1st Arizona to WellCare in 2017. Care1st California was renamed Blue Shield of California Promise Health Plan in 2019.
