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Claims forms

Blue Cross NC members can file a claim, appeal a denial of benefits, and learn more about their coverage depending on their type of plan. Please note, most providers in the Blue Cross NC network will file a claim on your behalf. Also view our tips for submitting claims to avoid claim mail backs.

For benefits received on a cruise ship, please submit the domestic claim forms.

International Claim Form (PDF)

Reclamo Internacional (Spanish) (PDF)

The claim form only applies if your health plan offers a travel benefit. You must sign the form to verify that you traveled out of state for a medical service covered and approved by your health plan.

Member Travel Benefit Claim Form (PDF)

Appeals forms

As a member, you can use the member appeal form if you disagree with a coverage or payment decision. You can also use this form to appeal other adverse benefit determinations.

If you wish to appeal an underwriting decision, try one of the following:

  • Check your underwriting decision letter for appeal instructions.
  • Contact your local agent.
  • Call us at 888-922-3140.

Coverage forms

Frequently asked questions

In most instances you do not have to file your own claim. Usually, the participating provider will file a claim for you. However, you may need to file claims for vision and dental products or services.

If you need a claim form or help on how to file a claim, log in to Blue Connect and select Claims or call Customer Service at 877-258-3334 or write to:

Blue Cross NC Customer Service

P.O Box 2291

Durham, NC 27702-2291

Please mail dental claims to:

Blue Cross Blue Shield of North Carolina

Attn: Dental Blue Claims Unit

PO Box 2100

Winston-Salem, NC 27102

OR

Blue Cross Blue Shield of North Carolina

Attn: Dental Blue Select Claims Unit

PO Box 2400

Winston-Salem, NC 27102

To file a claim for prescription drugs you purchased from an out-of-network or non-participating pharmacy:

Please see your Member Benefit Booklet to confirm that your pharmacy benefits are offered through Blue Cross NC. In some cases, employers purchase prescription drug plans that contract with a vendor separate from Blue Cross NC

If your member ID card says Prime Therapeutics on the back, complete this Prime Therapeutics claim form (PDF) and mail it to:

PrimeMail

PO Box 650041

Dallas, TX 75265-0041

If you need to submit a claim, please mail it in time to be received by Blue Cross NC within 18 months after the service was provided. Claims not received within 18 months from the date the service was provided will not be covered, except in the absence of legal capacity of the member.

You have the right to request a formal appeal of the claim payment or denial. A detailed description of this process may be found in your Member Guide. Customer Service can also assist you in starting the appeal process.

Blue Cross NC will work with you to resolve the issue. For each step in the appeals process, there are specified time frames for filing a grievance and for Blue Cross NC to notify you or your provider of the decision.

 

You can check the status of a claim by logging in to Blue Connect. With Blue Connect, you can access the following information regarding a submitted claim:

  • Processing status
  • Date received
  • Billing and payment amounts
  • How much money has been applied toward deductible
  • Coverage ratios for any member covered on the policy

Blue Cross NC will mail a comprehensive Benefit Booklet to your home after you enroll. Your Benefit Booklet is also available on the Coverage page in your Blue Connect℠ member portal. It has detailed information about your specific benefits and covered services.

You'll find a lot of information on benefits, claims and other member services on our website and in your Blue Connect member portal.
Log in to Blue Connect to see your:

  • Member ID cards
  • Plan benefits
  • Claim status
  • Bill pay options
  • Deductible balances, copayment amounts, coinsurance percentages, and other out-of-pocket costs
  • Contact information in the Contact Preferences Center

Need help?
You can send a secure message anytime through Blue Connect or call 877-258-3334, Monday to Friday, 8 AM to 7 PM ET.

If you do not receive prior approval or certification for services (except emergency care or maternity), your claim may be denied, paid at a lower benefit or a penalty may be applied.

 

Prior approval and referrals depend on your plan. Visit the Coverage page of your Blue Connect℠ member portal to find the rules listed in your Benefit Booklet.