Jane Dotson
If you need to make a claim on your Blue Cross and Blue Shield medical insurance, the first step is to check if you are covered by the Blue Cross Blue Shield Global™ Core program. If you are, enter the first three letters or numbers of your member ID to access your international claim form and instructions. If not, you'll need to contact your local Blue Cross and Blue Shield (BCBS) company for assistance. You can find your local BCBS company online, or by using your home or work ZIP code in the Plan Finder. If your provider or pharmacy is in your plan's network, they will usually submit the claim for you. However, if you receive care outside of your plan's network, you will need to submit a medical claim form yourself.
| Characteristics | Values |
|---|---|
| Who can submit the claim? | If your provider or pharmacy is in your plan's network, they will submit the claim for you. If you saw an out-of-network provider, you will need to submit a medical claim form. |
| When to submit the claim? | Submit the claim by December 31 of the year following the year that you received the service. For example, if your service was provided on March 5, 2024, you have until December 31, 2025, to submit your claim. |
| How to submit the claim? | You can submit the claim online through MyBlue, a secure members-only website. You can also mail a paper copy of the completed form along with itemized bills to the specified address. Alternatively, you can fax your claims to the provided fax number. |
| What to submit? | You will need to submit a completed claim form, following the instructions provided. Include itemized bills for covered services or supplies. If you are enrolled in the FEP Medicare Prescription Drug Program (MPDP), note that this benefit only works in the US and US territories. |
| Where to find the claim form? | You can find the claim form by logging into your account and clicking on "My Claims". If you are eligible for the Blue Cross Blue Shield Global™ Core program, enter the first three letters or numbers of your member ID to access your international claim form. |
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What You'll Learn
Submitting a claim for out-of-network providers
When you receive care from in-network providers, they usually submit claims to Blue Cross Blue Shield (BCBS) for you. However, if you choose to see an out-of-network provider, you will typically need to submit a claim for reimbursement yourself.
If you receive care from an out-of-network provider, you will need to complete and file a claim form to be reimbursed. You can submit your claim either online or by mail. Online claims are processed faster, and you can submit them from your computer or mobile device. You will also be notified immediately when your claim has been received.
To submit your claim online, log in to your account and select the Claims tab. Then, choose the 'Submit a Claim Online' option and enter the requested information about your claim. Don't forget to upload the required documents, including an itemized bill showing the services you received.
If you prefer to submit your claim by mail, you will need to download and complete the appropriate form. You can fill out the form electronically or by hand. Be sure to include itemized bills for covered services or supplies, and print and mail the form to your local Blue Cross and Blue Shield company. The address will depend on the state where the services were rendered.
It is important to note that you may have a specific deadline by which you must submit your claim. For example, with Blue Cross Blue Shield of Texas, you have 18 months from the date of service to submit a claim for reimbursement. Claims submitted after this deadline will be denied.
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Reimbursement for international travel
If you need medical care outside the U.S., Puerto Rico, and the U.S. Virgin Islands, Blue Cross and Blue Shield Service Benefit Plan offers worldwide coverage. Through the Overseas Assistance Center, you’re covered when working or travelling overseas.
If you have an overseas claim, you can find the relevant form and instructions at the Overseas Assistance Center. If you are eligible for the Blue Cross Blue Shield Global™ Core program, enter the first three letters or numbers of your member ID to access your international claim form and instructions. Otherwise, contact your Blue Cross and Blue Shield (BCBS) company for assistance.
You can submit your overseas medical and pharmacy claims online by logging on to the MyBlue® website or mailing/faxing in your claim. You can also call the customer service number on the back of your member card to access specific information about your coverage and claims.
If you are submitting a claim for prescription drugs, you will need to pay out-of-pocket and then submit your receipts and a completed claim form to get reimbursed. Overseas prescription drug claims must be submitted within one year of the purchase date.
Please note that the FEP Medicare Prescription Drug Program (MPDP) is only available to residents of the U.S. or a U.S. territory, and you cannot receive reimbursement for prescription drugs purchased overseas with this plan.
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Using the Real-time claims tool
The Real-time Claims tool is a web-based application that allows Blue Cross and Blue Shield members to submit and manage their medical and hospital claims efficiently. This tool offers several advantages and features to streamline the claims process and provide users with quick access to their claim information.
To start using the Real-time Claims tool, Blue Cross members need to request access from their account managers. This tool is particularly useful for Blue Shield fully insured Commercial PPO members with a single healthcare policy, HMO members where Blue Shield is financially responsible, and Covered California members with Individual and Family Plans (IFP).
One of the key benefits of the Real-time Claims tool is its estimator feature. This feature enables users to prescreen and estimate their claims in seconds, providing a quick turnaround time for claims assessment. The estimates are valid for seven days, allowing users to make informed decisions promptly.
Additionally, the tool assists in identifying submission errors and providing cost-share information before a claim is formally submitted. This feature helps prevent potential delays and ensures that claims are complete and accurate from the outset. The Clear Claim Connection (C3) simulation tool further enhances the claims process by allowing users to view claim auditing rules, payment policies, and clinical rationales. C3 is available for various plans, including Individual, Small Group, Employer Group, and Medicare Advantage plans.
The Real-time Claims tool also offers online submission capabilities, eliminating the need for paper-based processes. Users can submit claims electronically, attach relevant documentation, and receive immediate feedback on their submissions. This digital approach simplifies the claims process, reduces administrative burdens, and provides a faster and more convenient experience for Blue Cross members.
Overall, the Real-time Claims tool empowers Blue Cross and Blue Shield members to take control of their medical and hospital claims. By offering features such as estimation, error identification, and online submission, the tool streamlines the claims process, providing users with timely and accurate information to manage their healthcare finances effectively.
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Submitting a prescription drug claim
To submit a prescription drug claim to Blue Cross and Blue Shield's Federal Employee Program, you will need to fill out a claim form. You can download the form from their website, or you can fill it out electronically. You will need to include itemized bills for covered services or supplies.
If you are enrolled in the FEP Medicare Prescription Drug Program (MPDP), this benefit only works in the US and US territories. You cannot purchase prescription drugs and receive reimbursement for prescription drugs purchased overseas. If you are an overseas member, you will need to complete and file a claim form for any pharmacy services received and mail it to: CVS Caremark Medicare Part D Processing, P.O. Box 52066, Phoenix, AZ 85072-2066.
If you are not an overseas member, you can submit your claim online through MyBlue, a secure members-only website. You can also mail a paper copy of your claim form, along with your itemized bills, to: FEP Overseas PO Box 1568 Southeastern PA, 19399. You may also fax your claims to 610-293-3529.
Alternatively, you can print and mail the form to your local Blue Cross and Blue Shield company by 31 December of the year following the year you received the service. You can find your local company's address online. Make sure to submit a separate claim for each member.
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Accessing your login and benefits
If you are eligible for the Blue Cross Blue Shield Global™ Core program, you can access your international claim form and instructions by entering the first three letters or numbers of your member ID. If you are unsure about your eligibility, you can contact your local BCBS company for assistance. It is recommended to have your account number, paperwork, and any other important information to hand when you make contact.
If you are enrolled in the FEP Medicare Prescription Drug Program (MPDP), you can submit overseas medical and prescription drug claims online through the secure members-only website, MyBlue. You can also use MyBlue to access your personal health information anywhere you go. Alternatively, you can mail a paper copy of the form, along with itemized bills, to the specified address. Please note that the MPDP benefit only works in the US and US territories and does not cover prescription drugs purchased overseas.
If you have any questions about your coverage and claims, you can contact the customer service number on the back of your member card.
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Frequently asked questions
If your provider is in your plan's network, they will submit the claim for you. If you use a provider outside of your network, you will need to complete and file a claim form to be reimbursed. You can submit this form electronically or by hand.
You can search for doctors, hospitals, and dentists on your local Blue Cross and Blue Shield company website.
You will need to include itemized bills for covered services or supplies. You may also need to include a detailed receipt from the healthcare provider that lists all services performed and their costs.
