Bcbsnc Claim Form - Find out what to include with. Web learn when and how to submit a claim form for reimbursement from medical or dental services. Member information (see other side for instructions) id number. Do not file prescription drugs on this form. Check box if filing for glasses,. Use blue or black ink to complete. Blue cross nc members can file a claim, appeal a denial of benefits, and learn more about their coverage depending. Web use this form to request reimbursement for covered medical services that you paid for and were not billed to blue medicare.
Find out what to include with. Do not file prescription drugs on this form. Member information (see other side for instructions) id number. Blue cross nc members can file a claim, appeal a denial of benefits, and learn more about their coverage depending. Web learn when and how to submit a claim form for reimbursement from medical or dental services. Web use this form to request reimbursement for covered medical services that you paid for and were not billed to blue medicare. Check box if filing for glasses,. Use blue or black ink to complete.