How to File a Medical Claim
A claim must be filed before benefits can be determined. The claim must contain all of the information needed by BCBSMS to process the claim. Network providers have agreed to file claims for participants. See Time Limit for Claims Filing.
For care received from an out-of-network provider, a participant must receive the proper itemized bills from the provider and file a claim. A participant can get a medical claim form by calling BCBSMS at 800-709-7881. The form must be completed in its entirety to avoid delays in processing. Completed medical claim forms must be mailed to BCBSMS.
If another plan is primary, the claim must be filed with that plan first. Once an explanation of benefits (EOB) from the other plan has been received, the claim must be filed with BCBSMS. The claim must be filed with a copy of the other plan's EOB. If the other plan's EOB is not attached, the claim will be denied until the information is received.
If Medicare is primary, the claim must be filed with Medicare first. Once an explanation of Medicare benefits has been received, the claim must be filed with BCBSMS. The claim must be filed with a copy of the explanation of Medicare benefits. If the explanation of Medicare benefits is not attached, the claim will be denied until the information is received.