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Get Independence Blue Cross Physician Claim Inquiry Form

Mptly and accurately. Please mail completed form, Statement of Remittance, and supporting documentation to: IBC Claims Inquiry P.O. Box 7930 Philadelphia, PA 19101-7930 Member s Plan: Personal Choice PPO KHPE HMO KS65/PC65 Other: Practice Name Provider Number Street Address Name of Contact Person City State Zip Telephone Number ( ) Member Name Patient s Name Member ID Check Number Claim Number Date of Check or Explanation Date of Service Place of Service Detailed Inqu.

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p o box 7930 philadelphia pa 19101 7930 rating
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