151 form for anthem 2002-2025

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The document is a Claim Information/Adjustment Request form (151 Form) intended for providers to submit inquiries regarding insurance claims. It requires detailed information about the insured, claim type, patient details, and the nature of the inquiry, including reasons for adjustment requests such as overpayment or underpayment. The form must be completed and mailed to Anthem Blue Cross and Blue Shield for processing.

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Versions	Form popularity	Fillable & printable
2014	4.9 Satisfied (251 Votes)
2002	4 Satisfied (20 Votes)

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