Manage Claims & Records

We make it easy to manage your healthcare finances, claims and health information.

How to Submit a Claim

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, 2023, you have until December 31, 2024 to submit your claim). If you have questions, please contact your local Blue Cross and Blue Shield company.

Health Benefits 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.

• Download the health benefits claim form
  EnglishEspañol

• 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.

Dental Claims

• Download the dental claim form: English
• Complete the form following the instructions on the back. (You can fill the form in electronically or complete it by hand.)
• Print and mail the form to your local Blue Cross and Blue Shield company by December 31 of the year following the year you received service. Find your local company’s address.

Medicare Reimbursement Account Claims

Use this form to submit a claim to be reimbursed for paying Medicare Part B premiums. Submit a separate claim for each member.

Download the Medicare Reimbursement Account (MRA) Pay Me Back claim form:
English

Claims Administrator
P.O. Box 14053
Lexington, KY 40512

Overseas Claims

Overseas members must file claim forms for any covered medical or pharmacy services received outside of the United States. Submit a separate claim for each patient.

Submitting your overseas medical and prescription drug claims online is easy and provides faster processing and claims payment.

You can submit them through MyBlue, our secure members-only website. Use MyBlue to access your personal health information wherever you go.

Medical Claims

To submit by mail or fax, download the overseas medical claim form:

• Complete the form following the instructions on the form.
• Include itemized bills for covered services or supplies.
• You can mail a paper copy, along with your itemized bills, to:

• You may also fax your claims to us at 610-293-3529.

Pharmacy Claims

To submit by mail or fax, download the overseas retail prescription drug claim form:

• Print and complete the form according to instructions on the front.
• Attach pharmacy receipts for covered prescriptions.
• You can mail the form, along with your receipts, to:

• You can also fax your claim to us at 001-480-614-7674.

FEP Medicare Prescription Drug Program 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.

• Download the FEP Medicare Prescription Drug Program claim form

• Complete the form following the instructions on the back. (You can complete it electronically or by hand.)
• Include itemized bills for covered services or supplies.
• Print and mail the completed form with receipts to the address on the form.

Explanation of Benefits (EOBs)

An EOB is an outline of what services you received from a provider and how your benefits were applied to cover those services. You can view your personal EOBs through your MyBlue account.

Get More with MyBlue

Access a wealth of healthcare resources and tools with MyBlue. You can take the Blue Health Assessment, check drug costs, change your address, request a member ID card and more.

• National Information Center 1 (800) 411-BLUE

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