Webof Illinois (BCBSIL) and serving members in the state of Illinois. For additional information and requirements regarding provider claim disputes please refer to the Blue Cross Community Health Plans SM (BCCHP ) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM (MMAI) Provider Manuals. Please return this completed form and any … WebDownloadable Forms. Download the forms you need. Having trouble upload or viewing forms? Get help here. Living, Disability, Accident, Critical Illness, Vision and Dental Enrolment or Change Form — You allow use this form to enroll in any or all of our group ancillary products.; Beneficiary Designation — Use fork designating beneficiaries for life …
Forms Blue Cross and Blue Shield of Illinois Claim Submission ...
WebIf you have medical coverage, the following forms and documents are for you: Preferred Drug List (PDL) Mail Service Registration and Prescription Order Form. Member … Webcheck one: use one form per claim ) pre-treatment estimate ) statement of actual services 1. patient name first m.i. last 2. relationship to employee) self ) child ... blue cross and blue shield of illinois post office box 23059 belleville, illinois 62223-0059 8. emp/sub birth date mo. / day / year 9. employer (company) name and address 10 ... augusta health in staunton va
Claim Submission - BCBSIL
WebClaims Address: Blue Cross and Blue Shield of Illinois P.O. Box 805107 Chicago, IL 60680-4112. Human Resources Inquiries: 866-977-7378: Supplier Registration : If you … WebCommercial Claims. Mail original claims to BCBSIL, P.O. Box 805107, Chicago, IL 60680-4112. Government Programs Claims . There are different addresses for Blue Cross … WebBlue Cross and Blue Shield Companies are independent licensees of the Blue Cross and Blue Shield Association. International Claim Form Please see the instructions on the reverse side of this form before completing. Send completed form and documentation to: Service Center or [email protected] P.O. Box 2048 Southeastern, PA 19399 augusta jelly stone park