A claim is a description of services that a member has received from a doctor or other medical professional (sometimes referred to as a provider).
How to submit a claim
Claims are submitted to Blue Shield by a member, doctor or other medical professional when seeking reimbursement.
Generally, Blue Shield network providers will submit claims directly to Blue Shield.
If a member needs to submit a claim to Blue Shield directly, you must get an itemized list of services from the provider. It should include the following:
- Patient name
- Date of service
- Billed charge for each service
- Procedure code for each service
- Diagnosis code
- Provider name, address and tax identification number
Blue Shield must have this information to process the claim, and the information must come from the doctor.
In addition, if you are submitting the claim you must include the patient's Blue Shield ID number along with the above information supplied by your doctor.
Please send the above information to:
P O Box 272540
Chico, CA 95927-2540.
You can also Send a Message About a Claim. Again, make sure you give us as much information as possible to expedite your question.
Member Services makes every attempt to respond to your inquiry within two business days.
How to correct a claim
If the information in a claim is not accurate, please contact your provider's office. The provider will need to resubmit a bill with the correct information.
How to appeal a claim
Every claim is processed in accordance with the services reported and the benefits, exclusions and limitations of your health plan.
If your claim was denied and you believe that additional information will affect the processing of the claim, contact us.
If your question is not resolved to your satisfaction, refer to your Explanation of Benefits for the claim or read about our grievance process to see if you should file a grievance.