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Claim Action Request Procedures

PW_000554
Subsections:
When to Submit a Claim Action Request
Please submit claim action requests only when the claim has been processed through finalization, and the claim appears as paid or denied on your explanation of benefits or remittance advice (EOP/RA) or when you have received a letter requesting additional information before the claim can be processed. A claim action request may be needed as the result of a processing error, correcting claim information, missing or incomplete information, etc.  
Anthem provides the claim action request process as an informal way for Providers to request reconsideration of a claim determination made by Anthem. The claim action request process isn’t the same as an appeal. However, it’s often the quickest way to process a claim reconsideration. 
Please note: Please direct claim status inquiries to our interactive voice response (IVR) system, to our website at anthem.com (see the Customer Service and e-Business section) or to provider customer service (see the Telephone/Address Directory section for the phone numbers). Sending claim status inquiries via a Claim Action Request Form will delay the response to your inquiry. 
How to Submit an Action Request
Requests must be submitted on a Claim Action Request Form, completed entirely.
Submit only one action request on each Claim Action Request Form.
Include the corresponding claim control number for each action request.
Specify in detail the issue and the action requested.
Attach all documentation to support the action request, i.e., medical records, letter of appeal, corrected claim form, etc.
 
How to Obtain an Claim Action Request Form
You can download and print the form here. The form is a Word document that can be completed electronically. You can also call provider customer service at the phone number in the Telephone/Address Directory section to receive a copy. 
Where to Send Your Completed Action Transmittal Forms
For local Colorado members (alpha prefixes starting with XF) and BlueCard® members (all alpha prefixes other than XF or R + 8 numerics): 
Anthem Blue Cross and Blue Shield/HMO Colorado
P.O. Box 5747
Denver, CO 80217-5747 
For Federal Employee Program (FEP) members (alpha prefix R + 8 numerics):
Anthem Blue Cross and Blue Shield
Federal Employee Claims – Colorado
PO Box 36310
Louisville, KY 40233-6310
 
Who to Contact with Questions About Actions
Please call provider customer service (see the Telephone/Address Directory section for the phone number). 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. 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 Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use