Tips For Processing Your Anthem Blue Cross/Blue Shield Medical Forms

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Following are the steps to file a medical claim through Anthem Blue Cross/Blue Shield for out of network health care services:

1. Go to this site and DO NOT log in: http://www.anthem.com/verizon/

2. On the right/top is a menu – click on CLAIM FORM (link below).
http://www.anthem.com/member/noapplication/f1/s0/t0/pw_b135776.pdf

3. Print & save the form to your computer for future use.

4. If you have multiple doctors, it’s best to use one form for each doctor.  You can put up  to three appointments for the same doctor on each claim form.

5. Make a copy of your provider’s bill (you will attach a copy to claim form you mail).

ALL CLAIMS MUST BE ACCOMPANIED BY THE PROVIDER’S BILL

Service provider’s bill MUST include the following information:

  • Name, address, phone for provider, lab or hospital
  • Name of patient
  • Service provided
  • Date of Service
  • Amount charged for each service
  • Diagnosis code
  • Procedure code
  • Tax ID #

6.  Claim Form Sections:

  1. Patient information
  2. Subscriber member Information (name & info on Medical card)
  3. Where services were rendered (office, outpatient, lab etc.)
  4. If claim is related to an accident, workers comp. etc.
  5. Date of Service, Diagnosis Code, Procedure Code, Doctors Tax ID number, amount of bill.
  6. At bottom of claim form, sign your name, print your name and date.
  7. FOR YOUR FILES:  Make a COPY of the signed claim form and attach the provider’s ORIGINAL bill.  Keep record of date of mailing.
  8. MAIL TO ANTHEM BC/BS:  Make a copy of the PROVIDER’S BILL, staple to your COMPLETED & SIGNED CLAIM FORM and mail to:

Anthem Blue Cross & Blue Shield
P.O. BOX 105187
Atlanta, GA  30348-5187

Main ANTHEM BC/BS Customer Service phone number (Health Coverage): 855-869-8139
Employee Assistant Program (EAP) phone number: 888-441-8674
24/7 Nurse line phone number: 866-534-8434
Behavioral Health phone number: 888-441-8674
Medical Management phone number: 855-869-8139
Technical Web Site Problems Phone Number: 866-755-2680

Contact numbers and links here: Medical, Dental,Vision, Health

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