Home
Forms Library
International Claim Form

International Claim Form 2025

International Claim Form Preview on Page 1

Show details

4.6 out of 5

47 votes

The document is an International Claim Form from Blue Cross and Blue Shield, designed for submitting claims for medical services received outside the United States. It includes sections for patient information, other health insurance details, diagnosis, charges for services, payment options, and a signature section. The form requires detailed information about the patient, subscriber, treatment received, and associated costs to process claims effectively.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to edit International Claim Form in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Handling paperwork with our feature-rich and intuitive PDF editor is easy. Follow the instructions below to complete International Claim Form online easily and quickly:

Log in to your account. Log in with your email and password or register a free account to test the service prior to choosing the subscription.
Import a document. Drag and drop the file from your device or add it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit International Claim Form. Quickly add and underline text, insert pictures, checkmarks, and signs, drop new fillable areas, and rearrange or remove pages from your paperwork.
Get the International Claim Form accomplished. Download your adjusted document, export it to the cloud, print it from the editor, or share it with others via a Shareable link or as an email attachment.

Benefit from DocHub, the most straightforward editor to promptly handle your documentation online!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What does it mean for a claim to be issued?

The issuing of proceedings involves filling details of the claim, such as the Claim Form and Particulars of Claim, at court. The court will then serve this on the defendant for them to answer to.

What is a claim being filed against you?

A claim sets the stage for a potential lawsuit, serving as a precursor to litigation. It is essentially a demand for compensation due to the injuries and losses suffered by the claimant.

What is the purpose of a claim form?

A claim form is a formal written request to the government, an insurance company, or another organization for money that you think you are entitled to ing to their rules.

What happens if you receive a claim form?

If you have received a claim form, usually on Court form N1, it means that someone (the claimant) is suing you. If you ignore the claim form, the claimant will be able to enter judgment against you, and then pursue you for the money they are claiming (using a bailiff for example).

What is a UB 92 claim form used for?

The UB92 form (CMS-1450) is a standardized billing form used by healthcare providers to submit insurance claims for inpatient and outpatient hospital services, as well as for some other types of medical services. It was used in the United States from the 1980s until 2007 when the UB04 form replaced it.

What is an international claim?

A legal cause of action brought by an international organization or actor against an international body (such as a State). Competence to bring an international claim requires the capacity to resort to the customary methods recognized by international law for the establishment, presentation, and settlement of claims.

What are the two types of claims forms?

The two most common claim forms are the CMS-1500 and the UB-04. These two forms look and operate similarly, but they are not interchangeable. The UB-04 is based on the CMS-1500, but is actually a variation on itits also known as the CMS-1450 form.

What happens if you dont respond to a claim form?

If the defendant does not reply to your claim, you can ask the court to enter judgment by default (that is, make an order that the defendant pay you the amount you have claimed because no reply has been received). You should do this as soon as possible after the 14 days have passed.

International Claim Form 2025

Here's how it works