Anthem Blue Cross Blue Shield Insurance Claim Form | PDF
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The Anthem Blue Cross Blue Shield Member Claim Form is designated for individuals covered under this medical insurance company. The form is provided to patients who have received health care assistance and seeking to be reimbursed for payment they made out of pocket.
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Be certain to ask your provider if they will bill a statement to Anthem Blue Cross and Blue Shield. You should only submit statements if the provider does not bill Blue Cross/Blue Shield directly. In order to receive benefits for prescriptions, or for any services by a provider who does not bill Blue Cross directly, you should only then complete the claim form. You would then attach itemized bills, and mail the white copy to the local Blue Cross and Blue Shield Plan in the state where the services are rendered. Keep a
duplicate copy for your records.
If you have any questions, concerns or require assistance, contact Anthem Blue Cross and Blue Shield Client Services at 1-800-845-3604.
To avoid the possibility of small billings being lost or separated from the claim form, it is requested that you attach these to an 8 1/2 x 11 piece of paper.
They encourage you to file any claims you may have within 90 days of the date of service. Refer to your Benefit Certificate for what is required for time limitations. Again, you only need to file claims if your providers are unwilling to do so for you.
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