Filing claim payment disputes for our commercial members is now available on Availity.com. When you have additional information to share about a claim that has been denied, filing the dispute electronically is a cost-effective and time-saving alternative to paper and fax. This application enhancement enables a fast, efficient, and streamlined process for filing claim disputes:
  • Supporting documentation can be digitally upload
  • Dispute inquiries are digitally available on your dashboard
  • Retrieve correspondence related to your dispute digitally through your dashboard
  • A digital history for electronically filed disputes is conveniently located in one place on your dashboard


Two-step claim payment dispute process
There are two steps to the claim payment dispute process, and both can be accomplished in one place -through Availity.com:

  1. Claim payment reconsideration: This is your initial request; asking us to investigate the outcome of a claim. Most issues are resolved during reconsideration, which we try to resolve within 30 days. In those instances when additional documentation is needed, the determination may go beyond 30 days. If this occurs, we will notify you. Access notifications about delays and determinations conveniently from your dashboard.
  2. Claim payment appeal: If you disagree with the outcome from the reconsideration determination, you may request an additional review. When submitting a claim payment appeal, include the additional information needed to help us understand why the claim requires additional review. If a claim payment appeal requires clinical expertise, it will be reviewed by the appropriate Anthem clinical professionals. We make every effort to resolve the claim payment appeals within 60 days. If additional information is required to make a determination, notification will be available on your dashboard.


Receive determination electronically
Anthem will review the claim payment dispute and communicate an outcome on Availity.com. Check the status of a claim payment dispute at any time from your dashboard. 


Attend a Training Webinar

For step-by-step instructions about how to submit a claim payment dispute through Availity, attend one of these convenient live webinars:

  • Tuesday, February 1, 2022 at 2:00 p.m.
  • Thursday, February 3, 2022 at 1:00 p.m.
  • Tuesday, February 15, 2022 at 1:00 p.m.
  • Thursday, February 17, 2022 at 2:00 p.m.


Register for training by logging onto Availity.com, select Help & Training, Get Trained and pick the session most convenient for you. Self-guided training is also available through Get Trained.


1528-0222-PN-GA



Featured In:
February 2022 Anthem Provider News - Georgia