... claims appeal. 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.

• For routine follow-up, please use the Claims Follow-Up Form. • Mail the completed form to: Anthem Blue Cross, P.O. Box 60007, Los Angeles, CA 90060-0007.

INSTRUCTIONS: Please complete this form and attach all supporting documentation. Please send to P.O. Box 60007, Los Angeles, CA. 90060-0007 to the attention ...

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The Member may also print the form, complete it, and send it to Anthem Blue Cross at the address below. Grievances or appeals received verbally by the Customer ...

Download forms, guides, and other related documentation that you need to do business with Anthem.

Members may mail or fax a written grievance/appeal letter or a completed grievance form which is available on the Anthem Blue Cross website or can be obtained ...

Please complete the form below. Fields with an asterisk (*) are required. •. Be specific when providing the description of dispute and expected outcome.

Mail the complete form(s) to: Blue Shield of California Promise Health Plan. Attn: Provider Dispute Resolution Department. P.O. Box 3829. Montebello, CA 90640.

Failure to adequately consider an enrollee's grievance. 1300.68(d)(8). E. Grievance and Appeals. Failure to maintain a log, as specified, of grievances ...