Insurer Appeal Playbook
How to Appeal a Elevance Health (Anthem BCBS) Denial
Elevance Health (Anthem BCBS) denied 5% of standard prior-authorisation requests in calendar year 2025 and overturned 75% of those denials upon provider appeal (KFF analysis of CMS-0057-F insurer disclosures, August 2026).
Published Overturn Rate:
75%
PA Denial Rate: 5%
Verified: Quarter 3, 2026
Elevance Health (Anthem BCBS) Appeal Levels & Timely Filing Windows
Stage 01
First Level Provider Appeal
Deadline: 180 days from initial notice
Format: Standard BCBS Provider Dispute Resolution Form
Stage 02
Second Level Grievance
Deadline: 60 days from Level 1 response
Format: Independent Physician Review Panel
Winning Appeal Tactics for Elevance Health (Anthem BCBS)
Submit electronic EDI 999 batch proof when fighting CO-29 timely filing rejections
Enclose Anthem Medical Policy document citations
Most Common Elevance Health (Anthem BCBS) Denial Triggers
01. CO-16 (Diagnosis pointer)
02. CO-29 (Timely filing)
03. CO-97 (Modifier 25 unbundling)
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