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The document is a Health Benefits Claim Form for Blue Cross and Blue Shield, designed for patients to submit claims for medical services. It includes sections for patient information, other health insurance details, Medicare coverage, employment status, diagnosis, charges incurred, and a signature line. Instructions emphasize the need for itemized bills and specific information regarding Medicare and other insurance claims. The form must be completed accurately to ensure timely processing of benefits.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (266 Votes)
2014	4.4 Satisfied (195 Votes)
2005	4.4 Satisfied (93 Votes)
1997	3.8 Satisfied (29 Votes)

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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.

What is the payer ID for claims?

The Payer ID or EDI is a unique ID assigned to each insurance company. It allows provider and payer systems to talk to one another to verify eligibility, benefits and submit claims. The payer ID is generally five (5) characters but it may be longer. It may also be alpha, numeric or a combination.

How do I file a Bcbsnc claim?

Most Blue Cross NC members can submit medical claims online through Blue Connect. Just enter some information, upload a copy of your receipt, and hit submit! If you prefer to submit a paper claim form, you can download the form you need, fill it out, and send it to the mailing address or fax number provided.

What is the payer ID 53589?

Blue Cross Blue Shield of Arizona Our clearinghouse uses payer ID 53589 for BCBS of Arizona.

What is the payer ID for BCBS Federal Employee Program claims?

All claims should be submitted electronically using BCBSTX Electronic Payor ID: 84980. If the provider must file a paper claim, mail claim to: Claim status may be obtained through the Availity Claim Status Tool or a web vendor of your choice or call Provider Customer Service at 1-800-451-0287.

What is federal employee program BCBS?

For 60 years, the Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Programor simply FEPhas provided health insurance to the federal employee workforce. We are proud to have been part of the Federal Employees Health Benefits (FEHB) Program since its inception in 1960.

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What is the phone number for FEP Blue claims?

What should I do? For all inquiries, feedback and suggestions regarding the fepblue mobile app, please call 1-800-411-BLUE (2583) and follow the prompts for MyBlue support.

Is Fep Blue the same as BCBS?

The Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program (FEP), has been part of the Federal Employees Health Benefits (FEHB) Program since its inception in 1960.

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What is the payer ID for claims?

How do I file a Bcbsnc claim?

What is the payer ID 53589?

What is the payer ID for BCBS Federal Employee Program claims?

What is federal employee program BCBS?

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