Skip to main content

Knowledge Center

How to submit a claim

Need to submit a claim for medical services you received? Learn about when and how to file a claim.

When should you submit a claim?

You should submit a claim

You might need to submit a claim to Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to get reimbursed or paid back for covered services you received.

You might need to submit a claim when you:

  • Visit an out-of-network provider.
  • Receive medical services in another country (use the international claim form) or while on a cruise ship (use the member claim form).
  • You’re being reimbursed for vision or prescription products or services.1

You might not need to file a claim

You might not need to submit a claim when you:

  • Visit a North Carolina hospital for services or emergency care. If they have your insurance information, they'll file your claim for you.
  • Use an in-network doctor. Need help finding an in-network provider? You can search for in-network doctors all in one place.

What to include with your claim


To avoid delays and have your claims processed accurately, be sure you submit all of the following:2

Claims forms

You'll need to download, complete, and sign a claim form for each member who received care.

  • Most claims forms ask you to include additional documents or info.

Receipts

Your doctor will give you an itemized receipt for all the services you received.

  • You'll submit the original receipt with your claim.
  • Keep a copy of your receipt and claim form for your records.

Procedure codes

Ask your doctor for a list of all the procedure codes they used for your visit. You need to get:

  • A different procedure code for each service.
  • A separate charge for each procedure code.    

Diagnosis codes

You'll need a diagnosis code for services or supplies.

  • You can get diagnosis codes from your doctor as well.

Claims forms and how to submit them

You can download the claims forms you need, fill them out, and submit them to the listed mailing address, email, or fax number provided.

Read each form carefully for important details about additional documents you may need to send with your completed claims form.

Note: Use the member claim form if you needed health services on a cruise ship.

You may need these claim forms for services received or rendered outside of the US:

Note: Use the international claim form for health services you received while traveling outside the US.

The member travel benefit 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.

Already submitted a claim?

If you've submitted a claim and you want to know the status, you can look it up in your Blue Connect℠ member portal under your profile.

Get in touch with us

Our North Carolina customer service team is here to help.