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.
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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.
Disclosures:
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You can submit a claim for reimbursement of prescription products. Prescriptions filled within the last 7 days may be reimbursed at the pharmacy.
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Please allow at least 7 days for us to receive your claim. You can check the status of your claim on Blue Connect.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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