Use this direct reimbursement form when you have used a non-network pharmacy, or when you did not present your ID card at a network pharmacy during the first 30 days of eligibility.Īccess claims-for the entire family-by logging in to Anthem. Use this form if you paid out of pocket for a covered service received outside of the U.S. Enter the requested contact and claims information and submit. You can use Availity to submit and check the status of all your claims. NPI, address, or phone), please submit the Network Provider Change Form to providernetwork.
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