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Click ‘Get Form’ to open the capital blue cross provider dispute form in the editor.
Begin by filling out the 'Member Information' section. Enter your name, date of birth, address, and contact numbers accurately to ensure proper identification.
In the 'Claim/Service You are Appealing' section, provide details about the hospital or doctor involved, including their addresses and any relevant service dates.
Clearly state your reason for the appeal in the designated area. Be concise yet thorough to support your case effectively.
Sign and date the form at the bottom. If you are appointing a representative, ensure they complete their section with all required information.
Review all entries for accuracy before submitting. Once completed, you can easily download or share your filled form directly from our platform.

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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.

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What is the timely filing limit for Capital Blue Cross claims?

Contact Member Services at 800.730. 7219 (TTY: 711) if you need help submitting a medical claim. All claims must be submitted within 12 months from the date of service with the exception of claims from certain state and federal agencies.

Is there a timely filing limit for Capital District Physicians health Plan?

For uninsured PrEP-AP clients, all medical claims (e.g., new, corrected, or resubmitted claims) must be submitted no more than 180-days from the clients date of service. For insured PrEP-AP clients, there is no timely filing deadline for medical claims.

Are Capital Blue Cross and Blue Cross Blue Shield the same?

Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association.

Is Capital Blue Cross the same as Anthem?

If you have any questions regarding your renewal, call the Statewide Customer Service Center (CSC) at 1.877. 395.8930.

What is Blue Cross timely filing?

Timely Filing Limit for BCBS (Blue Cross Blue Shield) in Different States Insurance CompanyTimely Filing Limit for Initial Claim (From the date of service) BCBS Texas 95 Days BCBS Vermont 180 Days BCBS Wyoming 60 Days Anthem California 90 Days34 more rows

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