New process to submit claim payment disputes electronically
- Claim payment reconsideration: This is the first step in the Anthem provider payment dispute process. The reconsideration represents your initial request for an investigation into the outcome of the claim. Most issues are resolved at the claim payment reconsideration step.
- Claim payment appeal: This is the second step in the Anthem provider payment dispute process. If you disagree with the outcome of the reconsideration, you may request an additional review as a claim payment appeal.
Currently, providers can submit claim payment disputes through our Claim Action Request form (for a reconsideration), or through the Provider Dispute Resolution form (for an appeal).
Beginning in early November we will start a limited launch with designated providers. In early December all providers will have the ability to submit claim disputes electronically through the Availity Portal (our secure web-based provider tool). In addition, the provider manual will be updated in the near future to outline this new electronic process.
For providers, this means an enhanced experience when:
- Filing a claim payment dispute.
- Sending supporting documentation.
- Checking the status of your claim payment dispute.
- Viewing your claim payment dispute history.
For step-by-step instructions to submit a dispute:
- Log into Availity at availity.com
- Select Help & Training | Find Help
- Under Contents, select Overpayments and Appeals
- Select Dispute a Claim
Once a claim payment dispute is submitted through Availity, Anthem will review the request and communicate an outcome through the Availity Portal back to the Availity user. If the provider still disagrees with the reconsideration, the provider can then choose to appeal the claim payment.
Once the claim payment dispute is submitted for a second time, the decision is final, and may not be submitted again.
To learn more about the claim dispute tool, register for a live webinar:
- Log in to Availity and select Help & Training | Get Trained
- Select Sessions and go to Your Calendar to locate a webinar
- Select View Course and then select Enroll
The Availity Learning Center will email you with instructions to attend.
Scheduled live webinars:
- October 4, 2018, 2-3 p.m. EST
- October 24, 2018, 2-3 p.m. EST
- November 1, 2018, 2-3 p.m. EST
- November 6, 2018, 2-3 p.m. EST
- November 27, 2018, 2–3 p.m. EST
- December 6, 2018, 2–3 p.m. EST
- December 13, 2018, 2–3 p.m. EST
October 2018 Anthem Provider Newsletter - CO