• Benefits and Claims

    Benefits Summary

    Standard Option Basic Option

    Overview 

    Medical Benefits 

    Pharmacy Benefits 

    Dental Benefits 

    Overview 

    Medical Benefits 

    Pharmacy Benefits 

    Dental Benefits 

    Benefits Information

    2014 Benefits Booklet – View the 2014 Service Benefit Plan booklet

    2013 Benefits Booklet – View the 2013 Service Benefit Plan booklet

    Frequently Asked Questions – Answers to questions about enrollment, eligibility, ID cards, the BlueHealth Nurse Connection and other topics.

    Document Archive 

    Claim Status and Eligibility

    Register or login to check your claim status and eligibility.

    Note: Claim status and eligibility are available 24 hours a day except Sunday, 4:00 AM – 9:00 AM Eastern Time.

    Contract Holders can also request an ID card, change personal information and make changes due to a life event.

    Submitting a Claim

    • Download and complete the correct claim form.
    • Make copies of relevant billing and benefits statements from the provider.

    For services received in Alaska or Washington: 

    • Determine where to mail your claim by consulting the claims submission map and following the instructions.
    • View exceptions for ambulance, durable medical equipment (DME), laboratory services and pharmacy claims.

    Traveling Members: for services received outside of Alaska or Washington:  

    Correspondence

    • For services received in Alaska or Washington, consult the claims submission map to determine the mailing address for correspondence. View exceptions for ambulance, durable medical equipment (DME), laboratory services and pharmacy claims.
    • Consult the local Blue Cross Blue Shield Plan directory to determine where to send correspondence for services rendered outside Alaska and Washington.

     

     

    Exceptions

    Ambulance Claims – Send your claim or correspondence to the Blue Cross Blue Shield plan in the state where the ambulance picked up the patient. Example: An ambulance picks up the patient in Oregon and transports her to a care facility in Washington. The ambulance claim will be processed by Blue Cross Blue Shield of Oregon. Consult the FEP local plan directory to find addresses and telephone numbers for other plans. Note: If the pick-up location is in Washington, refer to the Washington claims submission map to determine where to send your claim for processing.

    Durable Medical Equipment (DME) – Send your claim or correspondence to the Blue Cross Blue Shield plan in the state from which the durable medical equipment was sent. Example: You live in Seattle and order parts for a wheelchair from a company in Montana. Blue Cross and Blue Shield of Montana will process the claim. Consult the FEP local plan directory to find addresses and telephone numbers for other plans. Note: If the equipment was sent from a DME provider in Washington, refer to the Washington claims submission map to determine where to send your claim for processing.

    Laboratory Services – Send your claim or correspondence to the Blue Cross Blue Shield plan in the state where the laboratory work was sent for testing. Example: The lab service you used is in Arizona but the sample was sent to Nevada for analysis. Blue Cross and Blue Shield of Nevada will process the claim. Consult the FEP local plan directory to find addresses and telephone numbers for other plans. Note: If the laboratory work was sent to Washington for testing or analysis, refer to the Washington claims submission map to determine where to send your claim for processing.

    Pharmacy

    • Standard Option and Basic Option Retail Pharmacy Claims – Download and complete a claim form then mail it to: BCBC SBP Retail Pharmacy Program, P.O. Box 52057, Phoenix, AZ 85072-2057
    • Standard Option Mail Order Prescription Orders – send to: Express Scripts, PO Box 30496, Tampa, FL 33633-1524