In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Virginia: Anthem Health Plans of Virginia, Inc. and underwritten by Matthew Thornton Health Plan, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO products underwritten by HMO Colorado, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits.
RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc.
(RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Connecticut: Anthem Health Plans, Inc. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.Īnthem Blue Cross and Blue Shield (Anthem) provider claims dispute processĪnthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. No DOR is required when the provider is appealing on their own behalf. A signed Designation of Representation ( DOR) is needed if the provider is appealing on behalf of the member.Specific reason(s) for disagreement with decision.The Anthem claim, authorization or reference number and the date of service.The following information is required when submitting a clinical appeal: Providers and facilities have 180 calendar days to file a clinical appeal from the date they receive notice of Anthem's initial decision, unless otherwise specified in your contract. A clinical appeal is a request to change decisions based on whether services or supplies are medically necessary or experimental/ investigative.Ĭlinical appeals can be made verbally, by using Interactive Care Reviewer for appeals, or in writing to: If you disagree with a clinical decision, you may request a clinical appeal review. If you disagree with the outcome of Step one: Claim payment reconsideration, you may request an additional review as a claim payment appeal.Ī claim payment appeal can be submitted through Availity, or in writing to:Ī claim payment reconsideration must be submitted prior to submitting a claim payment appeal.Ī claim payment appeal must be submitted within 30 days from the date of the determination of the claims payment reconsideration, unless otherwise specified in your contract. Step two: Claim payment appeal - Step two in the claim payment dispute process All supporting statements and documentation.
ANTHEM DEFINITION PDF
The simplest way to define a claim dispute is when the claim is finalized, but you disagree with the outcome.įor more information on the claim dispute process, please see the table below, or reference the attached PDF titled " Anthem provider claims dispute process." If you disagree with the outcome of a claim, you may begin the Anthem Blue Cross and Blue Shield (Anthem) provider claims dispute process.
0 kommentar(er)
