Claims Submission - Required Information for Professional Providers
This file provides detailed information on the required steps and data for professional providers to submit claims to Anthem Blue Cross. It outlines key information needed on the CMS-1500 Health Insurance Claim Form or its electronic equivalent. Compliance with these guidelines is necessary to ensure timely and accurate reimbursement.
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How do I fill this out?
To fill out this form correctly, ensure you provide all necessary patient and insurance information. Make sure to include accurate codes and details for the procedures performed. Following these steps will help ensure your claim is processed smoothly.
How to fill out the Claims Submission - Required Information for Professional Providers?
1
Gather patient and insured information.
2
Complete CMS-1500 Claim Form or its electronic equivalent.
3
Include accurate service and procedure codes.
4
Submit the form electronically or as a paper claim.
5
Ensure all fields are legible and correctly filled out.
Who needs the Claims Submission - Required Information for Professional Providers?
1
Healthcare providers for submitting claims to Anthem.
2
Medical billing professionals to ensure accurate claims processing.
3
Insurance coordinators for maintaining compliance with Anthem's guidelines.
4
Clinic administrators for managing reimbursement processes.
5
Healthcare IT specialists for electronic claim submissions.
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Use the PDF editor to make necessary changes.
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Download or share the edited document.
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Ensure the final edited PDF meets all necessary requirements.
What are the instructions for submitting this form?
Submit completed forms to Anthem Blue Cross electronically via EDI, or mail paper claims to the address provided in the provider manual. Ensure all fields are legible and accurately filled out. For additional instructions, refer to your provider manual or contact Anthem support. Submission instructions: Anthem Blue Cross, P.O. Box 60007, Los Angeles, CA 90060-0007, Fax: +1 (888) 243-3312
What are the important dates for this form in 2024 and 2025?
Ensure timely submission of claims throughout 2024 and 2025 to avoid delays. Regularly check for updates to coding requirements and reimbursement policies.
What is the purpose of this form?
The purpose of this form is to facilitate the accurate submission of claims to Anthem Blue Cross by professional providers. It ensures that all necessary patient and service information is included, enabling timely and accurate reimbursement. Compliance with the guidelines helps avoid claim rejections and payment delays.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Information: Includes name, address, date of birth, gender, and medical condition.
- 2. Insured's Information: Includes member ID number, name, address, policy number, and insurance plan details.
- 3. Coordination of Benefits: Includes information on other insurance plans or programs.
- 4. Referring Physician: Name of the referring physician or source.
- 5. Outside Laboratory: Indication if an outside laboratory was used.
- 6. ICD-10-CM Diagnosis Code: The diagnosis code corresponding to the medical condition.
- 7. Date of Service: The date when the service was rendered.
- 8. Place of Service: The location where the service was provided.
- 9. Procedures/Services: Description of services using CPT-4 or HCPSC codes and modifiers.
- 10. Charges for Services: The amount charged for each service rendered.
- 11. Day or Units: The number of days or units related to the service rendered.
- 12. Total Charges and Amount Paid: The total amount charged and the amount already paid by the patient.
- 13. Federal Tax Identification Number: The provider's federal tax ID number.
- 14. Service Facility Information: The name, address, and NPI of the facility where services were rendered.
- 15. Billing Provider Information: The name, address, and NPI of the billing provider.
- 16. Signature: Indication of provider's signature on file.
- 17. National Drug Code: The NDC number, unit price, quantity, and composite measure per drug.
What happens if I fail to submit this form?
Failure to submit this form correctly may result in claim rejection or denial. Avoid unnecessary delays by ensuring all required information is included.
- Claim Rejection: The claim may be rejected if required information is missing or incorrect.
- Payment Denial: Anthem may deny payment for the services rendered.
- Delayed Reimbursement: Incomplete or incorrect claims can lead to delays in reimbursement processing.
How do I know when to use this form?
- 1. New Claim Submission: To submit a new claim for services rendered.
- 2. Service Details: When providing detailed information on the services rendered.
- 3. Reimbursement: When seeking reimbursement for healthcare services.
- 4. Coordination of Benefits: To provide information on multiple insurance plans.
- 5. Medical Necessity: To support the medical necessity of the services rendered.
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What information is required on the CMS-1500 form?
Include patient, insured, and service details as instructed.
Can I submit the form electronically?
Yes, electronic submissions are preferred.
How do I ensure the form is legible?
Use a dark, large font and avoid any alterations.
What happens if the form is not filled out correctly?
Anthem may reject or deny the claim.
Can I download the edited form?
Yes, you can download it after editing.
Is there any support for filling out the form?
Refer to provider manuals and state-specific guidelines.
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