Prior Authorization & Claims

Claims & Appeals

To submit claims and appeals or check status of a claims appeal:

Log In to Availity

or

Provider Claim Dispute Process

Providers who disagree with the outcome of a claim can dispute that outcome when the claim is finalized. The payment dispute process consists of two internal steps. Providers will not be penalized for filing a claim payment dispute.

  1. Claim payment reconsideration. This is the first step and must be completed within 60 calendar days of the date of the provider’s remittance advice.
  2. Claim payment appeal. This is the second step in the process. This is if the provider disagrees with the outcome of the reconsideration and must be submitted within 30 days of the date on the decision letter.

Both steps can be done via Availity, fax or mail. Reconsiderations can also be submitted verbally through Provider Services.

For more information regarding the claim payment dispute process, please refer to Chapter 13 in the Provider Manual.

Indiana Health Coverage
Programs fee schedule

 

Hoosier Healthwise and Hoosier Care Connect

Visit the Indiana Health Coverage Programs fee schedule for reimbursement information for standard CPT, HCPCS and current dental terminology codes. Reimbursement for rendered services is based on negotiated rates.

Healthy Indiana Plan (HIP)

HIP pays at Medicare rates or 130% of Indiana Medicaid rates if no Medicare rate exists. Visit the CMS fee schedule for Medicare reimbursement information. If no Medicare rate exists, visit the Indiana Health Coverage Programs fee schedule for Medicaid reimbursement information. Exception: Facility charges for individuals that qualify as low-income parents and caretakers, and 19- and 20-year-old low-income dependents enrolled in HIP will be reimbursed at Medicaid rates.

Looking for claims forms?

Mail Paper Claims to:

Anthem Blue Cross and Blue Shield
Claims
Mail Stop: IN999
P.O. Box 61010
Virginia Beach. VA 23466

Page Last Updated: 03/09/2021