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L (non-hospital) claim to your local Blue Cross/Blue Shield office. WHO SHOULD USE THIS FORM Non-California participants, if you are submitting a claim to your local Blue Cross/Blue Shield office and the medical bill from your provider is not in the same format as the attached Medical Claim Form. You should attach a Medical Claim Form to each itemized bill that you submit. Medical providers, if you are filing a claim on behalf of a participant but you do not use the same CMS1500 format.

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