Filing a Medical Claim for Services Received in the United States

Follow the steps below to file a claim from a non-network provider for services received in the U.S.

To avoid a delay in the processing of your claim, be sure you have an updated Coordination of Benefits form on file with the Health Plan before submitting your claims to Anthem Blue Cross.

Step 1: Download the Claim Form – Medical – Services Received in the U.S.

NOTE: For fastest processing, you must include both a completed claim form AND your itemized bill.

Step 2: Complete your claim form in its entirety and attach your itemized bill.

Your itemized bill must include the following:

• Name and address of provider
• Place of service (i.e., doctor, hospital, laboratory, ambulance service, etc.)
• Name of patient
• Description of service
• Date of service
• Amount charged for each service
• Diagnosis code
• Procedure code
• Tax ID
• National Provider ID (NPI)

For Ancillary charges on Durable Medical Equipment or Lab work performed by an independent laboratory, Anthem will require both the rendering provider’s NPI and the ordering/referring provider’s NPI numbers. For other medical claim submissions where health information is submitted to insurance, the medical provider should include their NPI number.

Step 3: Submit your claim.