Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Anthem Blue Cross and Blue Shield (New York BlueCross BlueShield - NYBCBS) before sending sensitive documents. FaxFlow is not affiliated with this organization.
Anthem Blue Cross and Blue Shield (New York BlueCross BlueShield - NYBCBS) fax number
(877) 278-2163
Provider Clinical Appeals / Grievance and Appeals Department
Used for: Retro-Service Appeal (retroactive medical necessity appeal) for denied services, via fax to 877-278-2163
Fax destination details
- Department
- Provider Clinical Appeals / Grievance and Appeals Department
- Purpose
- Retro-Service Appeal (retroactive medical necessity appeal) for denied services, via fax to 877-278-2163
- Form
- Form 102082 - Provider Clinical Appeal Request — Provider Clinical Appeal Request
- Address
- PO Box 5063, Middletown, NY 10940
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Only use this form to request an appeal for medical necessity for which you have received an initial denial letter from Utilization Management. Indicate if the date of service is retrospective, whether expedited review is requested, and provide member/denial details with supporting documentation.
Official form instructions are published as a downloadable file on the organization's website.
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