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Medical Claim Form - UC Health Plans
Please be sure that duplicate bills are not submitted. Medical Claim Form instructions: Please send claims to: Anthem Blue Cross. P.O. Box 60007.
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CMS1500 (PDF)
HEALTH INSURANCE CLAIM FORM. OTHER. 1. MEDICARE. MEDICAID. TRICARE. CHAMPVA. READ BACK OF FORM BEFORE COMPLETING SIGNING THIS FORM. 12.
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SC-100 Plaintiffs Claim and ORDER to Go to Small Claims
Read this form and all pages attached to understand the claim against you and to protect your rights. Bring witnesses, receipts, and any evidence you need
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