Highmark bcbs provider appeal form

Instructions: Complete the section below and the address section on the following screen. Once you begin your request, you must complete it in one session as you will not be able to save it and complete at a later time. Once you submit an Initial Provider Credentialing Request, you will not be able to change and re-submit. Use this form to appeal or dispute a rejected BlueCard® claim. ID: 5373 Appeal Form - Post Service Medical Necessity Decision Use this form to appeal a claim determination involving a post service medical necessity decision made by Horizon BCBSNJ. ID: 32325 Appeal Form - Waiver of Liability Statement within one Highmark Blue Shield business day to discuss the determination with the requesting physician. To request a Peer-to-Peer contact, call 1-866-634-6468. Requirements In Processing Appeals Highmark Blue Shield's process for reviewing appeals follows all applicable regulatory requirements. These include the following components: Medicaid: 1-800-392-1147. 8am to 8pm, Monday through Friday. Medicare: 1-800-685-5209. October 1 through March 31: 8 am to 8 pm, 7 days a week. April 1 through September 30: 8 am to 8 pm, Monday through Friday. (TTY# 711 for hearing impaired) Or, you can email us. Contact Us. Appeals Administrator RE: APPEAL Statewide Benefits Office 97 Commerce Way, Suite 201 Dover, DE 19904 Tel: (302) 739-8331/ Fax: (302) 739-8339 Email: Benefits@delaware.gov Page 3 of 4 Highmark Blue Cross Blue Shield Delaware is an independent licensee of the Blue Cross Blue Shield Association. 12/2020 Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, an EE-0218-2022 Provider Complaint Form Because complaints are helpful feedback, Highmark Health Options has created this system for providers to raise issues with our policies, procedures, and administrative • To submit a Clinical Provider Highmark Blue Shield of Northeastern New York is a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross BlueShield Association. R14563-A-11-21 . PROVIDER INQUIRY FORM . If you are an electronic biller, please submit this . request electronically through the Electronic You can download a PDF of the Provider Directory HERE. Enter your zip code, click on the plan name and select Provider/Pharmacy Directory, then click Download. If you would like a paper copy of your Provider or Pharmacy directory, we will gladly mail it to you. Call us at 1-866-677-8565 (TTY users call 711) so that we can help. To check claims status or dispute a claim: From the Availity homepage, select Claims & Payments from the top navigation. Select Claim Status Inquiry from the drop-down menu. Submit an inquiry and review the Claims Status Detail page. If the claim is denied or final, there will be an option to dispute the claim. Provider Forms & Guides. Easily find and download forms, guides, and other related documentation that you need to do business with Anthem all in one convenient location! We are currently in the process of enhancing this forms library. During this time, you can still find all forms and guides on our legacy site. 5am to 3am. 5am to 3am. 5am to 3am. 5am to 11pm. 5am to 9pm. Hours of availability are given in Eastern Time and indicate the times you can transact with a health plan using NaviNet. independent licensees of the Blue Cross and Blue Shield Association. APPEAL REQUEST FORM Please submit th