To submit the completed BlueCross BlueShield Claim Form, you may send it via mail to BlueCross BlueShield, P.O. Box 660044, Dallas, Texas 75266-0044. Alternatively, fax your submission to the designated number provided by your insurance carrier. Ensure all necessary documents, including itemized bills, are attached to avoid processing delays. Follow any additional submission guidelines explicitly stated on the form.

Important dates for submitting claims typically align with the end of the coverage year. Ensure to submit any claims by December 31 to allow for processing in the current year. Check with your BlueCross BlueShield provider for specific deadlines.

The purpose of the BlueCross BlueShield Claim Form is to facilitate the processing of healthcare claims for insured patients. It ensures that healthcare providers get reimbursed for the services provided, while patients can access the benefits they are entitled to under their health plans. This form serves as the official request to initiate the claim process.

• 1. Insured/Subscriber Name: Full legal name of the insured and subscriber.
• 2. Group Number: The specific group number associated with the insurance plan.
• 3. Insured/Subscriber Identification Number: Identifying number as it appears on the ID card.
• 4. Mailing Address: Where correspondence regarding the claim will be sent.
• 5. Patient's Full Name: Name of the patient receiving treatment.
• 6. Patient's Sex: Indicate the patient's gender.
• 7. Patient's Date of Birth: The birthdate of the patient.
• 8. Type of Treatment Received: Specify whether the claim is for injury, illness, preventive care, etc.
• 9. Diagnosis: Provide a brief description of the diagnosis or symptoms reported.
• 10. Total Amount for Services: The overall cost of services rendered that need to be claimed.

If the form is not submitted, you may miss out on reimbursable expenses for healthcare services. Failure to submit the claim may result in the inability to recover costs associated with medical treatments. Always ensure timely and complete submission to avoid any issues.

• Claim Denial: Incomplete or missing submissions can lead to automatic denial of the claim.
• Delays in Reimbursement: Claims not submitted in a timely manner may delay reimbursements.
• Out-of-pocket Costs: Without proper submissions, patients may have to bear full costs of their treatments.

• 1. Post Treatment Claims: When you have received services and need to claim for reimbursement.
• 2. Provider Submissions: When healthcare providers need to ensure payment for services.
• 3. Insurance Verification: When confirming eligibility for benefits under the insurance policy.