INSURER FILING GUIDE

Anthem Blue Cross and Blue Shield (Georgia)

Use this public information to prepare your packet, then confirm the route on the insurer's own page.

AT A GLANCE

Claim facts

Member form	Medical Claim Form Number: 24066MUMENABS Revision: Rev. 1/19 Open the insurer form
Portal upload	NO
Portal path	No upload path: ACA transparency page instructs complete form plus itemized bill and mail it
Mail address	Anthem Blue Cross and Blue Shield, P.O. Box 105187, Atlanta, GA 30348-5187
Fax	Not published by the insurer
Attachments	Provider name and address; patient name; service provided; service date; amount for each service; diagnosis code; procedure code; tax ID
Deadline	90 days for Individual ACA plans
Outcome and status	Anthem member account or Sydney Health app
Processing time	Not published by the insurer
Caveats	Individual ACA source; HMO or EPO ordinary out-of-network benefits may be absent; employer self-funded terms differ; Medicare and Medicaid excluded

STEP BY STEP

Read date: 10-09-2026

Confirm that the plan has out-of-network benefits. The cited claim deadline applies only to Individual ACA plans. https://www.anthem.com/microsites/transparency-in-coverage.html
Download Medical Claim Form 24066MUMENABS Rev. 1/19 and complete a separate form for each patient and provider. https://www.anthem.com/docs/24066MUMENABS-fillable.pdf
Attach an itemized bill containing provider name and address, patient name, service, service date, charge for each service, diagnosis code, procedure code, and tax ID. https://www.anthem.com/docs/24066MUMENABS-fillable.pdf
Sign and date the certification. https://www.anthem.com/docs/24066MUMENABS-fillable.pdf
Submit within 90 days for an Individual ACA plan. Employer and self-funded plan deadlines are NOT PUBLISHED on this page. https://www.anthem.com/microsites/transparency-in-coverage.html
NOT PUBLISHED: a member portal or app upload path. The public Individual ACA instructions publish offline submission only, so portal_upload is NO. https://www.anthem.com/microsites/transparency-in-coverage.html
Check claims and EOBs in the Anthem member account or view claims in Sydney Health. Processing time is NOT PUBLISHED. https://www.anthem.com/member-resources/claims

Portal upload: NO
Portal: Anthem member account
Portal path: No upload path: ACA transparency page instructs complete form plus itemized bill and mail it
Mail address: Anthem Blue Cross and Blue Shield, P.O. Box 105187, Atlanta, GA 30348-5187
Fax: NOT PUBLISHED
Attach: Provider name and address; patient name; service provided; service date; amount for each service; diagnosis code; procedure code; tax ID
File types: NOT APPLICABLE
File size limit: NOT APPLICABLE
Maximum files: NOT APPLICABLE
One file or separate files: NOT APPLICABLE
Confirmation: EOB after processing; member account shows claims and EOBs
Status check: Anthem member account or Sydney Health app
Processing time: NOT PUBLISHED
Member deadline: 90 days for Individual ACA plans
Deadline basis: YES: employer and self-funded plan documents control
Mental health route: NOT PUBLISHED: no state-specific psychotherapy member filing carve-out found

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.

Read on 10-09-2026 from https://www.anthem.com/docs/24066MUMENABS-fillable.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.