Dispute resolution compliance

This is an important reminder that any dispute regarding reimbursement, including non-payment of services, must comply with the Dispute Resolution terms of your Anthem Blue Cross (Anthem) Participating Agreement. 

Your contractual remedy is to contact Anthem for assistance and to initiate the dispute resolution process if necessary which requires binding arbitration if our Anthem Workers’ Compensation Customer Relations group cannot resolve your dispute. Please note the Workers’ Compensation Appeals Board (WCAB) does not have jurisdiction over Anthem participating provider agreement disputes specifically regarding amounts to be paid as defined in LC5304 below.

 

Labor Code 5304:

The appeals board has jurisdiction over any controversy relating to or arising out of Sections 4600 to 4605 inclusive, unless an express agreement fixing the amounts to be paid for medical, surgical or hospital treatment as such treatment is described in those sections has been made between the persons or institutions rendering such treatment and the employer or insurer.

Therefore, filing of liens against Other Payors at the WCAB is not consistent with this policy and will result in escalation of such lien filings to the contract compliance department.   Should you have questions regarding your Anthem contract reimbursement, please contact Anthem Workers’ Compensation’s Customer Relations team at (866) 700-2168 or email your questions to AWCCustomerRelations@anthem.com. All pricing inquiries require a copy of the bill and the Explanation of Review (EOR). Submissions may be returned if incomplete information is received.