Download a claim form for medical services, pharmacy services or overseas care. Medical Forms Health Benefits Claim Form

This form can be downloaded from the following link: www.fepblue.org. You can also call 1-800-624-5060 for more information, claim forms and customer service ...

All forms must be signed, then either faxed or mailed. General forms. FEP claim forms (fepblue.org) - A one-stop source for FEP claim forms.

All forms must be signed, then either faxed or mailed. General forms. FEP Forms (fepblue.org) - A one-stop source for FEP claim forms.

Direct Reimbursement Claim Form. Important Information: 1. Use this form to request reimbursement for services received from providers who do NOT participate ...

Follow the instructions on the prescription drug claim form and submit the completed form to: Blue Cross and Blue Shield Service Benefit Plan Retail Pharmacy ...

Instructions · Download CMS 1500 or UB04 form · Print and complete form · Mail paper claim form and any supporting documents to. Blue Cross NC PO Box 35. Durham, ...

Use this claim form to submit eligible pharmacy expenses for reimbursement. You have to submit one claim form for each person and each prescription.

Here you'll find the forms most requested by members. To download the form you need, follow the links below.

THIS CLAIM FORM MUST BE SIGNED. IF NOT, IT WILL BE RETURNED. I certify that the above information is correct and apply for benefits under my dental.