You can use Availity to submit and check the status of all your claims and much more. Questions about Claims: If you have a question about a specific claim submitted or about an EOB you received, pleasecontact MDwise at 1-83. That’s why Anthem uses Availity, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to healthcare professionals. Providers are encouraged to submit claims electronically as this helps to ensure more timely processing. If a member has other health coverage, the provider submits a corresponding claim or encounter data for every service provided, with claim detail identical to that required for fee-for-service claims submissions. MDwise providers must submit complete and accurate claims/encounter data as outlined in your MDwise contract. All hard copy claims are stamped with date of receipt. The receipt date of a claim is the date that MDwise receives either written or electronic notice of the claim. Providers have 90 days from the initial claim determination to submit a dispute.ģ65 days from the date of service within the first 30 days of lifeĢ1 business days from the date of receiptģ0 business days from the date of receiptģ0 calendar days from the date of receiptĪccording to 42 CFR § 447.45, the Centers for Medicare & Medicaid Services (CMS) define a clean claim as one submitted by a provider for payment and processed without obtaining additional information from the provider of service or a third party. Providers may also call our Provider Customer Service Unit at 1-83. New users will need to request an account. Providers can access the myMDwise provider portal to quickly view the status of their claims. On June 21, 2019, Anthem Blue Cross notified their network and contracted Medicare Advantage (MA) providers about a shorter timely filing limit that will become effective as of October 1, 2019. MDwise Quick Contact Guide provides the most up-to-date contact information for MDwise. Further information on claim submission and guidelines can be found in the Provider Manual. Please be aware that in-network providers have 90 days from the date of service to submit claims.
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