Electronic (EDI) Claims
Anthem’s preferred method of claims submission is electronic through Availity. This process streamlines your claims, improves response time, and enhances correction capabilities. In addition, it provides you with a record of your claim upload.
Create an Account with Availity
In order to submit claims via EDI through Availity, you must first Log In or Register as necessary with the Availity Essentials Portal at www.availity.com. For assistance, contact Availity at (800) 282-4548.
To Submit Claims:
For Professional Billing Payer ID: 00803 | For Hospital/Facility Billing Payer ID: 00303 |
Submit claims up to December 31, 2024 using HCP’s Payer ID number with Availity: 11328.
Helpful Tips for Successful EDI Transmission
- Submit EDI claims with the Provider’s full and proper name and National Provider Identifier (NPI) number.
- Verify that the Member’s first and last names, health plan ID, and date of birth match eligibility records. Mismatched patient information may result in the rejection of your claim.
- Retain copies of your EDI transmission acceptance reports as evidence of transmission.
Paper Claims
All paper claims must be mailed to:
Elevance Health
P.O. Box 1407
Church Street Station
New York, NY 10008-1407
Helpful Tips for Successful Paper Claim Submission
- Be sure to properly complete your claim form. Any missing or omitted information may lead to a delay in processing or rejection of your claim.
- Always include your Tax ID Number and NPI (National Provider Identification) number.
- The Centers for Medicare and Medicaid Services (CMS) requires that ICD-10 codes be submitted at the highest level of specificity. Failure to submit the most specific ICD-10 code(s) may result in rejection of your claim.
- Do not use colored highlighters on your claim forms. All paper documents are scanned using light-sensitive equipment. Highlighted areas can become fully obscured during the scanning process.
Timely Filing
The timely filing for Medicaid, Medicare, and Commercial claims is: within 120 days of the date of service. Where HCP is the secondary payor under Coordination of Benefits, the time period shall commence once the primary payor has paid or denied the claim.
To Check Claim Status, Verify Member Eligibility, or for Benefit Inquiries and Claim Reconsideration
You can reach Elevance (Anthem BCBS) directly at (800) 676-2583.
Out-of-Network Providers Submitting Medicare Advantage Claims
For claim denials that resulted in partial or zero payment: You are only permitted to file a standard appeal for a denied Medicare Advantage claim if you complete a Waiver of Liability, which states that you will not bill the member regardless of the outcome of the appeal.
You must file the appeal within 60 calendar days from the date of this explanation of payment.
