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  • Blue Cross/blue Shield Of Massachusetts Drug Claim Form - Hr Williams

Get Blue Cross/blue Shield Of Massachusetts Drug Claim Form - Hr Williams

CF-BCBS-DMR 22113 DRUG CLAIM FORM BlueCross BlueShield of Massachusetts 1. 2. 3. 4. 5. Please type or print clearly. All information in each section must be provided. All forms must be accompanied.

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Call the number on the back of your BCBSIL member ID card to ask for your Form 1095-B to be mailed to your address on file within 30 days. If you can't find this number, you can also call 1-855-710-6984. Once this form is received, your Form 1095-B will be mailed to your address on file within 30 days.

To submit: Start your reimbursement online through MyBlue. Sign in to MyBlue. Go to Pharmacy Benefit Manager under My Medications. ... Mail-in form. Complete, print, and mail the CVS Caremark Over-the-counter, at-home COVID-19 Test Reimbursement Claim Form* found here.

Use payor ID 03036 to submit claims electronically. Call your clearinghouse or Change Healthcare at 1-800-266-2206 for help submitting claims.

How do I enroll? Complete the form on page two and fax it to 1-617-246-4482.

Paper submission 1500 form to:UB-04 form to:ADA 2012 form to:Blue Cross Blue Shield Data Capture PO Box 986020 Boston, MA 02298Blue Cross Blue Shield Data Capture PO Box 986015 Boston, MA 02298Blue Cross Blue Shield Process Control PO Box 986005 Boston, MA 02298

Simply enter the organization's name (TUFTS HEALTH PUBLIC PLANS INC) or EIN (800721489) in the 'Search Term' field.

If you need our Federal Tax ID number, it is 04-1045815. If you have a specific medical or insurance issue, please call Member Service at the number on the front of your ID card, or Sign in to MyBlue and use our secure inquiry form.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232