For reimbursement complete items 1-11 of the claim form, attach receipt(s) and submit to:
FOR CLAIMS IN CALIFORNIA
Anthem Blue Cross of California
PO Box 60007
Los Angeles, CA 90060-0007
FOR CLAIMS OUTSIDE
Anthem Blue Cross/Blue Shield of the state the medical services were performed. If you have questions, call 800-810-BLUE(2583).
If you need the provider reimbursed then also sign item 12 and following the same procedures listed above. One claim form per patient.