Please complete a separate claim form in full for each hospital and/or doctor bill being submitted. Please note: Additional information may be required to complete the processing of your claim.

Find and download commonly used member forms. We recommend Acrobat Reader to use forms in PDF format. Explore your plan options, determine your eligibility for financial help, get a price quote, …

To file a claim for those out-of-network services, you’ll need to use the claim form from the state where you were treated. Check the state-by-state list of Blue Cross Blue Shield companies to get started.

Complete this claim form for any traditional pharmacy services received. Use this form to order a mail order prescription. Use this order form for specialty medications. For more information about …

Browse commonly requested Anthem forms to find and download the one you need for various topics including pharmacy, enrollment, claims and more.

Authorization is hereby given to any Hospital, Physician, Dentist, Provider, Insurance Carrier or other entity to give Blue Cross and Blue Shield of Illinois, upon request, any medical information.

Please complete a separate claim form for each patient, and remember to file all claims by December 31 of the calendar year after the one in which the covered care or service was provided.

Use this form to submit a claim for a prescription drug charge if you have BlueRx Direct. * You may fill out and print this form using your PDF reader program.

Access claim forms for employer-sponsored health plans. Submit your claim hassle-free today!

Please note that this form is to be used only when the provider of service does not submit your claim directly to Blue Shield. Duplicate claims will not only be rejected but may delay payment of the …