Blue Shield Of California Claim Form
Download pdf pdf 75kb international claim form c14764. This form is used to submit claims directly to blue shield of california or blue shield of california life health insurance company when you ve received covered services outside of california. Https Www Blueshieldca Com Sites Stanford Documents Prescription Drug Reimbursement Claim Form 4 7 Pdf Convert them into templates for multiple use include fillable fields to collect recipients. Blue shield of california claim form . Complete the form following the instructions on the back. Any person who knowingly presents a false or fraudulent claim for payment of a loss is guilty of a crime. Blue cross blue shield claim form california. Blue shield of california p o. Out of state claims must be sent to the blue plan of the state in which services were rendered. You should only use this form when you are certain that the provider of service has not and will not submit a claim for you. Clear claim connection c3 is a sim