Home
Forms Library
Anthem blue cross claims form

Anthem blue cross claims form 2025

anthem blue cross claims form Preview on Page 1

See details

4 out of 5

31 votes

The document is a Patient Claim Form used to submit health care claims to Anthem Blue Cross. It collects essential patient and member information, details about the medical condition or treatment, and requires documentation for processing claims. The form outlines instructions for completion, including the necessity of itemized bills and additional information for specific services. It emphasizes the importance of accurate and complete submissions to expedite claim processing.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out anthem blue cross claims form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the anthem blue cross claims form in the editor.
Begin by filling out the Member Information section. Enter your name, ID number, and relationship to the member. Ensure all details are accurate for smooth processing.
Next, complete the Patient Information section. Include the patient's name, date of birth, and daytime phone number. If applicable, indicate if the patient is covered by Medicare.
In the Other Insurance Information section, specify if there is any other health insurance coverage. Provide details about the policy holder and insurance company if applicable.
List any prescription drugs in the designated area, ensuring to include purchase dates and costs. Attach all relevant medical bills as required.
Finally, review all entries for accuracy before signing at the bottom of the form. Your signature certifies that all information provided is correct.

Start using our platform today to easily fill out your anthem blue cross claims form for free!

See more anthem blue cross claims form versions

We've got more versions of the anthem blue cross claims form form. Select the right anthem blue cross claims form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2008	4 Satisfied (31 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How long do you have to file an appeal claim with Anthem?

You may file an appeal within 60 calendar days of the date on the letter we sent to tell you of our decision. You might be able to file an appeal even if 60 days have passed since we made our first decision. Tell us in your written request why you could not file within the 60 days allowed.

What is the Anthem timely filing limit?

Timely Filing Limit for BCBS (Blue Cross Blue Shield) in Different States Insurance CompanyTimely Filing Limit for Initial Claim (From the date of service) BCBS Texas 95 Days BCBS Vermont 180 Days BCBS Wyoming 60 Days Anthem California 90 Days34 more rows

How to look up Anthem claims?

To check claims status or dispute a claim: From the Availity home page, select Claims Payments from the top navigation. Select Claim Status Inquiry from the drop-down menu. Submit an inquiry and review the Claims Status Detail page. If the claim is denied or final, there will be an option to dispute the claim.

Does Blue Cross accept paper claims?

(You can fill the form in electronically or complete it by hand.) Include itemized bills for covered services or supplies. Print and mail the form to the Blue Cross and Blue Shield company in the state that the services were rendered by December 31 of the year following the year you received service.

How long do I have to file a claim with Anthem Blue Cross?

Anthem follows the standard of: 90 days for participating providers and facilities. 180 days for nonparticipating providers and facilities (For dates of service prior to January 1, 2019, 12 months for nonparticipating providers).

How long do you have to submit a claim to Anthem?

Anthem will consider reimbursement for the initial claim, when received and accepted within timely filing requirements, in compliance with federal, and/or state mandates. Anthem follows the standard of: 90 days for participating providers and facilities.

Are Anthem and Bluecross Blueshield the same?

Anthem is part of the Blue Cross Blue Shield group. Blue Cross Blue Shield is made up of independent companies. Anthem is one of these companies. Other Blue Cross Blue Shield brands include Highmark, Regence and CareFirst.

Anthem blue cross claims form 2025

Here's how it works

How to use or fill out anthem blue cross claims form with our platform