Get Member Claim Form 2008-2025

Filling out the Member Claim Form online is a straightforward process designed to ensure efficient and accurate processing of your claims. This guide provides detailed, step-by-step instructions to help you navigate each section of the form with ease.

Follow the steps to successfully complete the Member Claim Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information. Fill in the last name, first name, and middle name of the patient along with their birthdate. Indicate the patient's sex by selecting 'M' for male or 'F' for female. Make sure to specify the relationship to the subscriber, using options such as self, spouse, son, daughter, or domestic partner.
3. In the subscriber information section, fill in the details as they appear on the Anthem Blue Cross card, including group number and HCID number. Provide the home and work phone numbers, along with the complete address including city, state, and zip code.
4. Answer the question regarding other health insurance coverage. If applicable, include the name of the other health insurance company, policy number, and the patient’s health insurance identification number.
5. Proceed to the medical information section, where you will report any covered health services not already billed to Anthem Blue Cross by the provider. Attach itemized bills or photocopies for these services and ensure that duplicate bills are not submitted.
6. Indicate whether the medical expense was a result of an accident or job-related, and provide details such as the date of the injury or accident.
7. Document the healthcare services received. For each service, provide the date of service, the name of the provider, the illness or diagnosis, and the total charges for each service rendered.
8. If any services were provided by specific licensed professionals, make a note of the physician who authorized these services, if applicable.
9. Review your completed form for accuracy. Ensure all sections are filled out correctly and all necessary documentation is attached.
10. Once everything is complete, save your changes and choose to download or print the form. Follow the instructions on where to send the completed claim form to ensure it reaches Anthem Blue Cross.

Start filling out your Member Claim Form online today for quick processing of your health claims.