Anthem Claim Dispute Form For Reimbursement In Travis

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

Description

The Anthem claim dispute form for reimbursement in Travis is a structured document designed to facilitate the resolution of claims related to medical expenses. It serves as a formal request for reimbursement from Anthem, ensuring that users provide essential details about the claim in an organized manner. Key features include sections for user contact information, policy numbers, and specific claim descriptions, as well as a detailed list of the care provided. The form also includes instructions on filling out each section accurately to avoid processing delays. For attorneys, partners, owners, associates, paralegals, and legal assistants, this form is crucial for streamlining the claims process, safeguarding clients' rights, and ensuring compliance with insurance policies. It assists legal professionals in guiding clients through the complexities of reimbursement claims. Additionally, the clear language and structure of the form make it accessible for users with varying levels of legal experience, promoting effective communication with insurers. Overall, the Anthem claim dispute form is an invaluable tool for efficiently addressing reimbursement issues in the medical field.

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FAQ

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

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.

How to Find Timely Filing Limits With Insurance Insurance CompanyTimely Filing Limit (From the date of service) Anthem BCBS Ohio, Kentucky, Indiana, Wisconsin 90 Days Wellmark BCBS Iowa and South Dakota 180 Days BCBS Alabama 2 Years BCBS Arkansas 180 Days28 more rows

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: • 90 days for participating providers and facilities. 15 months for nonparticipating providers and facilities.

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.

Effective Date: January 1, 2024 Plan NameSingle (1)Two-Party (2) Anthem Blue Cross Del Norte EPO $1,240.19 $2,480.37 Anthem Blue Cross Select HMO $944.08 $1,888.16 Anthem Blue Cross Traditional HMO $1,221.90 $2,443.80 Blue Shield Access+ EPO $910.34 $1,820.6815 more rows •

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Anthem Claim Dispute Form For Reimbursement In Travis