Forms

Submitting a claim

Need to submit a claim or other form? You’ll find the most frequently used forms in the chart below. If you can’t locate what you need, call the advocacy service team at 833-960-4025 TTY: 711 or log in to My Account.

	BlueChoice Claim Form (PDF)
	Major Medical Claim Form (for 65+) (PDF)
	Prescription Drug Claim Form (PDF)
	Prescription Mail Order Form (PDF)
	Dental Claim Form (PDF)
	Vision Claim Form (PDF)
	Continuity of Care - Members in a Maryland Based Plan (PDF)
	Continuity of Care BC - Provider Not in Network (PDF)