Blue Shield Of California Medical Claim Form

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Patient care forms | Blue Shield of CA Provider

https://www.blueshieldca.com/bsca/bsc/wcm/connect/provider/provider_content_en/guidelines_resources/forms_patient_care

BSC Promise Community Supports Referral Form (PDF, 199 KB) Claims Fax Coversheet (PDF, 59 KB) Coordination of Benefits Questionnaire (PDF, 71 KB) DMHC Member Grievance Form (PDF, 1.5 MB) DMHC Cancellation of Health Coverage Grievance Form (PDF, 243 KB) DOI Member Grievance (PDF, 1.6 MB) Home Care Referral (PDF, 530 KB) Language Assistance Request (PDF, 62 KB)

Member forms | Blue Shield of CA

https://www.blueshieldca.com/en/home/forms-unauth.html

Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier. You can get an interpreter. You can get documents read to you …

Claims Forms - Employer Connection - Blue Shield of …

https://www.blueshieldca.com/employer/administrator-resources/reference/forms/claims.sp

This form is used for medical services received outside of California. This is for …

Participant’s Statement of Claim - Blue Shield of …

https://www.blueshieldca.com/sites/oc/documents/Medical_Claim_Form_10-7_v1.pdf

Send this claim to: Blue Shield of California, P.O. Box 272540, Chico, CA, 95927-2540. Questions? Call: 1 (888) 235-1767, Monday through Friday, 7 a.m. to 7 p.m., PT. This …

Provider forms | Blue Shield of CA Promise Health Plan

https://www.blueshieldca.com/en/bsp/providers/policies-guidelines-standards-forms/provider-forms.html

Health Care Options: 1-844-580-7272, Monday through Friday from 8 a.m. - 6 p.m. TTY users should call 1-800-430-7077. For information on Blue Shield Promise Cal …

Forms And Applications - Producer Connection - Blue …

https://www.blueshieldca.com/bsca/bsc/wcm/connect/broker/broker_content_unauth_en/ifp/resources/forms-and-applications

Download the Blue Shield Global Core International Claim Form. Dental Claim Form (PDF, 560 KB) Vision Claim Form (PDF, 419 KB) Download a vision claim form for members …

Claims contacts | Blue Shield of CA Provider

https://www.blueshieldca.com/bsca/bsc/wcm/connect/provider/provider_content_en/about_pc/contact_us/contacts_claims

Blue Shield of California Promise Health Plan Provider Services: Phone: (800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday. Claims. Electronic Data Interchange (EDI) …

California Forms Library | Anthem.com

https://www.anthem.com/ca/forms/

International Claim Form (BlueCross BlueShield Global Core) (221 KB) Use this form to submit institutional and professional claims for benefits for covered services …