Presentación de reclamaciones

Filing your claims should be simple. That’s why Anthem uses Availity, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to healthcare professionals. You can use Availity to submit and check the status of all your claims and much more.

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Don't have an Availity account? You can register here.

Providers, improve your prior authorization and claims submission process. Our new online Clinical Documentation Lookup Tool (CDLT) gives real-time access to the highly recommended medical documents needed with submission.

 

Access the Clinical Documentation Lookup Tool 

 

GRS Hearing Aid Coverage Update

 

Effective 1 de enero de 2022

 

Many Group Retiree Solutions (GRS) plans now include the requirement that all hearing aids be supplied by Hearing Care Solutions (HCS).

 

If you are not an HCS provider and are going to fit a patient for a hearing aid, first verify the member’s out-of-network benefits and then follow the protocol outlined in the following document:

 

 Download the new protocol for hearing aids

Más recursos

EDI

 

Electronic Data Interchange (EDI) is the computer-to-computer exchange of business documents in a structured format. EDI provides a faster and cleaner method for delivering time-dependent data, saving you time compared to filing paper claims.

Apelaciones de proveedores

 

You have the right to request an appeal of a coverage decisions. You may request this appeal on your own behalf or on behalf of a covered Individual.

 

 

PPO and HMO Claims

 

These resources provide billing guidelines and submission requirements for PPO and HMO claims.  They include troubleshooting information, an overview of electronic billing and EDI contact information.


 

 Read about PPO and Select PPO submissions
 Read about HMO submissions

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Ready to become a provider in the Anthem network?

We look forward to working with you to provide quality service for our members.

 

Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place.

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