PPO Plans

To file a claim with Anthem Blue Cross, print the Anthem Blue Cross Medical Claim Form.  Complete all items on the claim form and attach all required documentation and mail to the applicable address based on the state in which the service was provided.  Complete a separate claim form for each patient.  Refer to the Anthem Master Claim Form Mailing List.  All claims need to be mailed within twelve (12) months of the date of service.

HMO Plan

If you require emergency medical care outside of the state of California and you need to file a claim form with Anthem Blue Cross HMO, print the Anthem Blue Cross Medical Claim Form.  Complete all items on the claim form and attach required documentation.  Mail the completed form to the Los Angeles address on the claim form.  Complete a separate claim form for each patient.  All claims need to be mailed within twelve (12) months of the date of service.

To file a prescription claim with a non-participating pharmacy, print the Prescription Drug Claim Form, complete all items in Section A - Cardholder/Patient Information.  Sign the form and include original prescription receipt(s).  Make copies for your records.  Complete a separate claim form for each participant. 

First-time Prescription Orders:  Obtain a written prescription from your physician; send the ORIGINAL prescription, along with the completed Express Scripts - Web Prescription Order Form to the address noted on the top of the form. 

Ordering Refill Mail Order Prescriptions:  You can refill your mail order prescription in one of the following ways:

1. Internet: www.anthem.com/ca 
2. Mail:  Use the pre-printed refill order form which is included with each of your mail order prescriptions.  Mail the pre-printed refill order form along with your payment to Express Scripts Mail Service Pharmacy.
3. Phone:  1-866-297-1013