Open "NCFlex Accident Claim Form 12.18. Pdf" and fill out form.This is where you begin when you have a claim. Complete a separate claim form for each provider. You've been in an accident - now what? This form enables us to calculate the correct compensation for an injured employee. This proof of claim form is used for filing a claim against North Carolina Mutual Life Insurance Company ("NC Mutual"). Most Blue Cross NC members can submit medical claims online through Blue Connect. Just enter some information, upload a copy of your receipt, and hit submit! Instructions for completing the standard CMS1500 claim form as it relates to the claim form field changes are listed below.