Anthem Voluntary Refund Form

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Overpayment Refund Notification Form Anthem

Refund Providers.anthem.com Show details

7 hours ago In order for an overpayment refund to be processed in a timely manner, please submit a completed form with all refund checks and supporting documentation. If the refund check you are submitting is an Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) check, please include a completed form specifying the reason for the check return.

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Provider Forms Anthem.com

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8 hours ago Provider Forms & Guides. Easily find and download forms, guides, and other related documentation that you need to do business with Anthem all in one convenient location! We are currently in the process of enhancing this forms library. During this time, you can still find all forms and guides on our legacy site.

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Overpayment refund notification form Anthem

Refund Providers.anthem.com Show details

3 hours ago Overpayment refund notification form In order for an overpayment refund to be processed in a timely manner, please submit a completed form with all refund checks and supporting documentation. If the refund check you are submitting is an Anthem Blue Cross (Anthem) check, please include a completed form specifying the reason for the check return.

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Provider Communications

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3 hours ago Submit the Provider Refund Adjustment Request Form with supporting documentation to have claim adjustment/recoupment done off a future remittance advice . When voluntarily refunding Anthem on a Claim overpayment, please include the following information: Provider Refund Adjustment Request Form (see directions below for how to access online)

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ANTHEM MIDWEST PROVIDER …

ANTHEM Anthem.com Show details

800-376-02476 hours ago Not an Anthem Member. Secondary – Refund To Us: $ Other: Please send other carrier information. Explanation: Signature _Date_ * This form and supporting documentation may be faxed to 800-376-0247. Please refer to the instruction sheet for additional addresses for mailing. Add/Delete/Replace. Date of service CPT/Revenue Code. Line Charge # of

Author: gibler
Last modified by: stricpt
Created Date: 5/8/2013 6:17:00 PM

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Overpayment Request Form Availity

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6 hours ago for the recoupment or refund of the monies overpaid. Please take a credit on a future payment in the amount of _____. We are returning the overpayment in the amount of _____. (See section to the right for applicable refund address.) Send Anthem Blue Cross and Blue Shield overpayment refund checks with this form to: CT Connecticut Recovery Lockbox

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Overpayment refund notification form Anthem

Refund Mediprovider.empireblue.com Show details

6 hours ago Overpayment refund notification form In order for an overpayment refund to be processed in a timely manner, please submit a completed form with all refund checks and supporting documentation. If the refund check you are submitting is an Empire BlueCross BlueShield HealthPlus (Empire) check, please include a completed form specifying the reason

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Provider Forms Anthem

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4 hours ago Resources Overview. Provider Manuals, Policies & Guidelines. Medical Policies and Clinical UM Guidelines. Forms. Provider Training Academy. Pharmacy Information. Learn About Availity. Referrals. HEDIS (The Healthcare Effectiveness Data & Information Set)

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Forms Library Anthem.com

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9 hours ago Forms Library. Members can log in to view forms that are specific to their plan. Please select your state. Our forms are organized by state. Select your state below to view forms for your area. Select My State.

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Provider Forms KY Provider Anthem

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2 hours ago As a leader in managed healthcare services for the public sector, Anthem Blue Cross and Blue Shield Medicaid helps low-income families, children and pregnant women get the healthcare they need. Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross and Blue

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Provider Forms Empire Blue Anthem

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2 hours ago Provider Forms & Guides. At Anthem, we're committed to providing you with the tools you need to deliver quality care to our members. On this page you can easily find and download forms and guides with the information you need to support both patients and your staff. All Forms & Guides. Forms.

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Forms Anthem Blue Cross and Blue Shield

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3 hours ago ©2021 copyright of Anthem Insurance Companies, Inc. Anthem Blue Cross and Blue Shield is the trade name of Compcare Health Services Insurance Corporation, an independent licensee of the Blue Cross and Blue Shield Association.

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California Forms Library Anthem.com

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2 hours ago CA 2021 Legacy Application Change Form. (N/A) CA Employer Application for Group Benefits (126+ lives) (111 KB ) CA Employer Application for Group Benefits (51-250 lives) (60 KB ) CA Group Change Form (517 KB) CA Large Group Employee Medical/Dental/Life Enrollment Form (574 KB) Provider Nomination Form - Dental (83 KB)

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Forms Anthem Blue Cross and Blue Shield Healthcare Solutions

Blue Providers.anthem.com Show details

Just Now 17P Prior Authorization Form. Maternity Notification Form. MCS Notification of Delivery Form. Other Forms. PCP Change Request form — English. PCP Change Request form — Spanish. Practice Profile Update Form. Sign up to receive email from Anthem Blue …

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Member Claim Form Anthem

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2 hours ago I certify that, to the best of my knowledge, the information on this Member Claim Form is true and correct. I authorize the release of any medical information necessary to process this claim. Signature . X . Name Date . Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association.

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Provider Communications COLORADO

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Just Now If Anthem is due a refund as a result of an overpayment discovered by a Provider or Facility, refunds can be made in one of the following ways: Submit a refund check with supporting documentation outlined below, or Submit the Provider Refund Adjustment Request Form with supporting

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Jurisdiction 15 Part B Voluntary Overpayment Refund

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3 hours ago This form, or a similar document containing the following information, should accompany every unsolicited/voluntary refund so that receipt of check is properly recorded and applied. Provider/Physician/Supplier or Other Entity Name Address Provider/Physician/Supplier Number Tax ID …

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Forms and documents Regence

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8 hours ago Find forms to request pre-authorization, care management or appeals, or direct overpayment recovery. Download and print helpful material for your office.

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Provider Communications

Provider Providernews.anthem.com Show details

3 hours ago Solicited Refund with Payment Coupon. Anthem Blue Cross and Blue Shield. Anthem Blue Cross and Blue Shield. PO Box 5281. Carol Stream, IL 60197. N/A. BlueCard, National. Voluntary & Solicited Refund with Payment Coupon. Anthem Blue Cross and Blue Shield. Anthem Blue Cross and Blue Shield. PO Box 73651. Cleveland, OH 44193-1177. Anthem. Attn

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Frequently Asked Questions

How do I access antanthem member services?

Anthem members: Download and log in to our new Sydney mobile app that's your special health ally for personalized wellness activities, 24/7 digital assistance and more. Medicaid members can access information with our Medicaid app. Or, call the Member Services number on the back of your member ID card.

What is the trade name of Anthem Blue Cross and blue shield?

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc.

What states does Anthem Insurance Company serve?

© 2005 - 2020 copyright of Anthem Insurance Companies, Inc. Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin.

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