Signature: Date: Check here if medical records are attached. Please do not staple medical records to this form. Check here if additional information is attached ...

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

Easily find and download forms, guides, and other related documentation that you need to do business with Anthem all in one convenient location!

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.

On this page you can easily find and download forms and guides with the information you need to support both patients and your staff.

Edit, sign, and share anthem provider dispute form online. No need to install software, just go to DocHub, and sign up instantly and for free.

By Phone: Call the number on the back of the member's ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative.

After Anthem Blue Cross has completed its review, a written statement of its resolution is sent to the Member and Provider within. 30 calendar days of receiving ...

Complete this form to file a provider dispute. This form must be included with your request to ensure that it is routed.