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Web provider forms & guides. Submission of this form constitutes agreement not to bill the patient during the. If the claim is denied or final, there will be an option to dispute the. Web provider dispute resolution request form. Easily find and download forms, guides, and other related documentation that you need to do. Web submit an inquiry and review the claims status detail page. Submission of this form constitutes agreement not to bill the patient during the. Web if you disagree with the outcome of a claim, you may begin the anthem blue cross and blue shield (anthem) provider payment. Web us on a pdr form which are not true provider disputes (e.g., claims check tracers or a provider's submission of medical records. Anthem blue cross and blue shield (anthem) provider claims dispute process. Web provider dispute resolution request. Web below are guidelines for a claims escalation process, provider payment dispute, and appeals process relating to claim.