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  • Blue Cross Blue Shield Enrollment Applicationchange To California Form

Get Blue Cross Blue Shield Enrollment Applicationchange To California Form

Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association 70313.1011 ENROLLMENT APPLICATION /CHANGE FORM INSTRUCTIONS PLEASE READ THOROUGHLY BEFORE COMPLETING ENROLLMENT APPLICATION / CHANGE FORM Use a black or blue ballpoint pen only. Print neatly. Do not abbreviate. SECTION 1 Check all the boxes that apply to indicate if you are a new enrollee or if you are requesting a change to your coverage. Indicat.

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Contact support

If you have questions related to Blue Shield Promise medical or pharmacy authorizations, contact Provider Services at (800) 468-9935.

Blue Cross and Blue Shield may be merged under the Blue Cross and Blue Shield Association in the majority of states. In California, however, Anthem Blue Cross and Blue Shield of California are two separate—and competing—health insurance companies with large networks.

For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357. Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.

Phone: (800) 541-6652, Monday - Friday, 8 a.m. – 5 p.m.

For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357. Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.

Dedicated Provider appeals line: Phone:(800) 541-6652. HMO and PPO: Blue Shield of California Initial Appeal Resolution Office. P.O. Box 272620. Chico, CA 95927-2620. Blue Shield 65 Plus (HMO): Blue Shield 65 Plus. Medicare Provider Appeals Department. P.O. Box 272640. Chico, CA 95927-2640. Fax: (855) 895-3501.

Fax: (916) 350-8860, Monday - Friday, 6:00 a.m. - 6:30 p.m.

FAX: 1-866-990-1385 PLEASE NOTE: If your other insurance or Medicare policy is primary, you must attach a copy of the Explanation of Benefits from that insurer. Your claim cannot be processed without this information.

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© Copyright 1997-2025
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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