Bcbs federal claim form 2026

See details

4.8 out of 5

266 votes

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 section. Instructions emphasize the need for itemized bills and specific information regarding Medicare and other insurance coverage to ensure proper claim processing.

Here's how it works

01. Edit your 19049 f 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 bcbs federal claim form via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out bcbs federal claim form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the BCBS Federal Claim Form in the editor.
Begin by filling out the Patient Information section. Enter the patient's name, identification number, date of birth, and sex. Ensure accuracy as this information is crucial for processing your claim.
In the Other Health Insurance section, indicate if the patient has additional coverage. If yes, provide details about the insuring company and policy holder.
Complete the Medicare section if applicable. Fill in all relevant dates and checkboxes regarding Medicare coverage.
Describe the diagnosis in Section 5. Include details about any accidents related to treatment, specifying dates and locations.
List all charges in Section 6. Attach itemized bills for each service provided, ensuring they meet submission requirements.
Finally, sign and date the form in Section 7. Remember that failure to sign may delay processing.

Start using our platform today to easily fill out your BCBS Federal Claim Form online for free!

See more bcbs federal claim form versions

We've got more versions of the bcbs federal claim form form. Select the right bcbs federal claim form version from the list and start editing it straight away!

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)

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 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.

fepblue reimbursement form

Bcbs federal claim form pdf Blue Cross Blue Shield claim form PDF Bcbs federal claim form online BCBS FEP provider appeal form Fepblue submit claim online Blue Cross Blue Shield reimbursement forms Bcbs FEP Claims address Blue Cross Blue Shield claim form online

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.