Need to submit a claim? Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. (For example, if your service was provided on March 5, 2019, you have until December 31, 2020 to submit your claim). If you have questions, please contact your local Blue Cross and Blue Shield company.
Health Benefit Claims-
If you use a provider outside of our network, you’ll need to complete and file a claim form to be reimbursed. Use this form to submit a health benefit claim for services that are covered under the Blue Cross and Blue Shield Service Benefit Plan. Submit a separate claim for each patient.
Complete the form following the instructions on the back. (You can fill the form in electronically or complete it by hand.)
Include itemized bills for covered services or supplies.
Print and mail the form to the Blue Cross and Blue Shield company in the state that the services were rendered by December 31 of the year following the year you received service. Find your local company’s address.
Use this form to submit a claim to be reimbursed for services that are covered under Service Benefit Plan dental benefits. Submit a separate claim for each patient.
We pledge to honor and support all caregivers who are vitally needed at this time. Because we’re in this together. You can learn more here.