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.
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.