How to 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 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.

You can submit a claim online in your member portal. You can also download, complete, and sign a claim form for each member who received care.

• Most claims forms ask you to include additional documents or info.

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.

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.

You'll need a diagnosis code for services or supplies.

• You can get diagnosis codes from your doctor as well.