Submitting claim payment disputes via Availity, the preferred method, as of November 20, 2021įor step-by-step instructions to submit a claim payment dispute through Availity:
When submitting a claim payment dispute in writing, providers must include the Claim Information/ Adjustment Request Form and submit it to: Submitting commercial claim payment disputes in writing
BLUE CROSS ANTHEM CALIFORNIA MANUAL
Please refer to the Provider Manual for additional detailsĪnthem will issue a written determination stating the pertinent facts and explaining the reasons for its determination within 45 working days after the date of receipt of the dispute. Whether the request for reimbursement is for the overpayment of a claim, contest, denial, adjustment, or other action.A clear explanation of the basis for which the Provider or Facility believes the payment amount should be.When submitting a claim payment dispute for commercial claims, please include as much information as you can including but not limited to the following: Providers may submit the claim dispute in writing effective November 20, 2021, via Availity providers are encouraged to submit all commercial disputes via Availity. Reminder on how the provider claim’s payment dispute process worksįor Anthem, the provider claim’s payment dispute process consists of the following:Ĭommercial claims payment dispute: A written notice to Anthem challenging, appealing or requesting reconsideration of a claim or clinical determination that has been denied, adjusted, contested, or seeking resolution of a contract dispute or disputing a request for reimbursement of an overpayment of a claim. * Reminder, Anthem will consider reimbursement of a claim that has been denied due to failure to meet timely filing if you can: 1) provide documentation that the claim was submitted within the timely filing requirements or 2) demonstrate good cause exists. Viewing the history of a claim payment dispute.Checking the status of a claim payment dispute.Sending supporting documentation to Anthem.
BLUE CROSS ANTHEM CALIFORNIA CODE
Some examples include manual processing errors, contract interpretation, reduced payments, code editing, eligibility, timely filing *and other health plan denials.Īnthem’s streamlined provider claim dispute process utilizing Availity across all Anthem lines of business, allows a more cohesive and efficient approach for providers when: Effective November 20, 2021, providers will now also be able to submit claim payment disputes via Availity for Anthem’s Commercial lines of business.Īs a reminder, unlike inquiries about claims status, provider disputes, or requests for additional information, provider claim payment disputes occur after a claim is finalized, and a provider disagrees with the claim payment Anthem has issued. As part of our streamlined provider claims payment dispute process, Anthem Blue Cross (Anthem) introduced the ability to submit claim payment disputes via Availity, for members enrolled in our Anthem Blue Cross Medicaid and Medicare Advantage benefit plans.
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