Claim Forms

 
Claim Forms

Medical Claims
Most hospitals and doctors will file your medical claim directly with the local Blue Cross and Blue Shield Plan. In the few instances where you may need to file the medical claim yourself, please download the Adobe Acrobat version of the Blue Cross and Blue Shield claim form. Help us avoid unnecessary delays by answering all questions completely and print clearly.

Mail your medical claim to the following address:
Blue Cross and Blue Shield of Illinois
P.O. Box 805107
Chicago, IL 60680-4112

See below for information regarding your behavioral health and prescription drug claims.

International Medical Claim Form
The BlueCard Worldwide International Claim Form is to be used to submit institutional and professional claims for benefits for covered services received outside the United States, Puerto Rico, Jamaica and the U.S.Virgin Islands. Download International Claim Form (PDF, 31KB).

Send completed form to:
BlueCard Worldwide Service Center
P.O. Box 72017
Richmond, VA 23255-2017 USA

Behavioral Health Claims
Because your behavioral health benefits are administered by Magellan Behavioral Health, please contact a Magellan representative toll-free at (800) 240-6227. Alta Vista and Hawaii employees should call (800) 851-7498.

Or visit Magellan's customized Web site to obtain claims information including forms and proper mailing address. If you are accessing the site for the first time:

  • Click on New or unregistered user in the Member Sign In box
  • Enter your Abbott program toll-free number as noted above and select Continue
  • From here, you can create a user name and password, or scroll down the page and click on Continue Unregistered.

Prescription Drug Claims
Because your prescription drug benefits are administered by Caremark, please contact a Caremark representative toll-free at (866) 293-8009 or visit Caremark online for more information.