Anthem Out Of Network Claim Form
You can now submit your form online or by mail.
Anthem out of network claim form. During this time you can still find all forms and guides on our legacy site. Ana central medical claim form instructions. Box 60007 los angeles ca 90060.
Click below to complete an electronic claim form. If your provider participates in the anthem vision network he she will file a claim with anthem vision. For out of state claims please contact customer service for the claims ofice address.
Member claim form instructions. If you choose an out of network provider please complete the following steps prior to submitting the claim form to blue view vision. Claim forms must be submitted within 15 months of the date of.
Colorado springs co 80921. Independent licensee of the blue cross and blue shield association. Anthem blue cross and blue shield is the trade name of anthem health plans of virginia inc.
For services rendered in california please send claims to p o. Registered marks blue cross and blue shield association. Anthem insurance companies inc.
Out of network benefits your next step is to send us your completed claim form. Anthem health plans of kentucky inc. Most blue view visionsmplans allow members the choice to visit an in network or out of network vision care provider.
43923ctmenabs 214 anthem blue cross and blue shield is the trade name for anthem health plans inc. Questions may be directed to anthem vision customer service at 888 799 6290. Anthem blue cross and blue shield po box 105187 atlanta ga 30348 5187 anthem blue cross and blue shield is the trade name of.
We are currently in the process of enhancing this forms library. If you will be using electronic assistive devices to complete the form please use the online form. Out of state claims must be sent to the blue plan of the state in which services were rendered.
Please send claims to. Green and get paid faster. Browse commonly requested forms to find and download the one you need for various topics including pharmacy enrollment claims and more.
Not all plans have out of network benefits so please consult your member benefits information to ensure coverage of services and or materials from out of network providers. Claim form see reverse side before filing our claim. Please send claim form and receipts to.
Complete and return the. An independent licensee of the blue cross and blue shield association.