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Er Name Individual NPI Organizational NPI Tax ID Number (National Provider Identifier) (if applicable) Office Address State Zip County State City Zip County Mailing Address City Office Phone Person to contact (if necessary) within above named provider s office Fax Number Patient Information Group Number Patient Name Group Number Contract Number Claim Number Total Amount (check one) Deduct Enclosed Sex: Remit Date $ Amount Approved by Male Female Date of Ser.

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Claims must be filed with BCBSIL on or before December 31 of the calendar year following the year in which the services were rendered. Services furnished in the last quarter of the year (October, November and December) are considered to be furnished in the following year.

If you don't have pharmacy benefits with BCBSIL/Prime, contact your health plan administrator for information about getting test kits and being reimbursed. For those with BCBSIL pharmacy benefits through Prime Therapeutics, your plan will cover the cost of FDA-authorized, over-the-counter diagnostic tests.

0:37 1:31 Did you receive a check from Blue Cross Blue Shield in the mail? It's ... YouTube Start of suggested clip End of suggested clip They collect from. You on services and activities for you as their member. And if they don't theyMoreThey collect from. You on services and activities for you as their member. And if they don't they have to refund their members that money. So not everyone is going to get a rebate.

You may view the Explanation of Benefits (EOB) by going to the Claims Center tab on Blue Access for Members (BAM). This will provide you with a complete list of your claims for the past 18 months. You will need to click on the claim number hyperlink in order to access the EOB.

Contact Us Contact Name/DescriptionURL/Email/Phone/FaxProvider Customer Service If you do not have online access, use our automated phone system for eligibility and benefits and other self-service requests1-800-972-8088 Monday - Friday 8 a.m. - 11:30 p.m. (CT), Saturday 6 a.m. - 3:30 p.m. (CT), Sunday - Closed12 more rows

Claims may be submitted one-at-a-time by entering information directly into an online claim form on the vendor portal; or batch claims may be submitted via your Practice Management System (check with your software vendor to ensure compatibility).

If the employee chooses to file a claim form, they can download the STD claim forms at bcbsil.com/ancillary/employees/forms. Once the forms are completed, they can email them to us at DisabilityClaimsIL@bcbsil.com, or they can fax or mail them to the number/address on the claim form.

Send Completed Claim Form To: Blue Cross and Blue Shield of Illinois. P.O. Box 805107. CHICAGO, IL 60680-4112.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232