How to Complete and Submit a Blue Cross of Idaho Claim Form

The Blue Cross of Idaho claim form is the document you submit to get reimbursed when you paid a healthcare provider directly, usually because the provider was out of network or did not bill the insurer. You can download the Member Claim Form from the Blue Cross of Idaho website or request a copy by calling customer service at 800-627-1188.¹ Once Blue Cross of Idaho receives a complete submission, it aims to respond within 30 days.²

What to Gather Before You Start

The attachment that matters most is an itemized statement from the provider who treated you. A credit card receipt or a “balance due” notice is not enough; the form instructions are explicit that the provider’s statement must include specific details for each service.³ Before you sit down with the form, pull together:

The provider’s name or ten-digit National Provider Identifier (NPI).
A procedure code (CPT or HCPCS) and a diagnosis code for each service.
The specific date each service was performed.
The charge for each individual line item.
Proof you paid the provider, such as a cancelled check, a credit card statement showing the transaction, or a receipt from the provider’s office.
Your Blue Cross of Idaho member ID and group number from your insurance card.

Attaching the payment receipt upfront is recommended by the form itself and avoids a follow-up request later.³

Filling Out the Form

The form is a single page, but a few sections cause most of the trouble.

Patient and Enrollee Information

Enter the patient’s full name and date of birth exactly as they appear on the insurance card. If the patient is a spouse or child, you still need to provide the enrollee’s information, because the enrollee holds the policy. When you are submitting for more than one family member, complete a separate form for each patient and attach a separate copy of the provider’s statement to each one, even if every service appears on the same bill.³

Other Insurance

The form asks whether the patient has any other health coverage, including another Blue Cross Blue Shield plan or Medicare.³ If the answer is yes, fill in the other carrier’s name, address, ID number, group number, and effective date, and check the boxes indicating which family members the other coverage applies to. Blue Cross of Idaho uses this to coordinate benefits between the two plans.⁴ Skipping this section when other coverage exists can delay or derail your claim.

Accidental Injury

If any service was related to an accident, such as a car crash, a fall, or a workplace injury, fill out the accidental injury section. The form warns that leaving it blank when services are accident-related could delay processing while the insurer determines whether a liability policy or workers’ compensation should pay first.³

Where the Check Should Go

You get a choice: have the reimbursement sent to you (the enrollee) or directly to the provider. If you already paid in full, check the “Enrollee” box and attach your proof of payment. If the provider is still waiting on payment, you can direct the check to them.³

Attachments and Signature

Circle the specific charges on the provider’s statement that you are submitting, then staple the statement to the back of the form. If you saw multiple providers, submit a separate form for each one with that provider’s statement attached.³ Sign and date the bottom. An unsigned form will not be processed.

Prescription Drug Claims Are Different

Pharmacy claims follow slightly different rules. The pharmacy receipt must include the National Drug Code (NDC), the name of the drug, the quantity dispensed, and the dosage.³ If your plan uses a pharmacy benefits manager such as CVS Caremark, the reimbursement request may need to go to the PBM rather than to Blue Cross of Idaho. Check the back of your member ID card for your PBM’s contact information.

How to Submit the Form

By Mail

Send the completed form, the itemized provider statement, and your proof of payment to:

Blue Cross of Idaho
P.O. Box 7408
Boise, ID 83707¹

Staple everything to the back of the form so nothing gets separated in processing. Keep photocopies of the whole package. If the envelope goes missing, you will not have to chase down duplicate bills from your provider.

Through the Member Portal

You can also submit and track claims through the Blue Cross of Idaho member portal at members.bcidaho.com.⁵ Scan the completed form and attachments as PDFs and upload them through the portal’s claims section. Digital submission is faster than mail and gives you a confirmation that the documents were received.

If You Were Treated Outside Idaho

If you received care from a provider outside Idaho, Blue Cross of Idaho may forward your claim to the Blue Cross Blue Shield plan in the state where the services were performed.³ The BlueCard program connects BCBS plans nationwide, so this routing is routine. Submit the form the same way you otherwise would.

What Happens After You Submit

Blue Cross of Idaho targets 30 days from receipt of your claim to its response.² Do not resubmit the same charges during that window. Duplicate submissions slow things down for everyone.³

Once the claim is processed, you will receive an Explanation of Benefits. An EOB is not a bill. It is a summary showing the care you received, what the provider charged, what Blue Cross of Idaho paid under your plan, and any amount still your responsibility.⁶ The EOB also explains why the claim was processed the way it was, which matters when only part of a charge was covered. If the claim is approved for reimbursement to you, the check goes to the address on file. You can track status in the member portal at any time.⁵

Mistakes That Delay Reimbursement

Most delays come from a handful of preventable errors:

A provider’s statement that lists only a total amount, without procedure and diagnosis codes for each service. Call the provider’s billing office and ask for a fully coded itemized statement.
Combining multiple providers on one form. Each provider needs a separate form with that provider’s statement attached.
Combining multiple patients on one form. Even when the whole family saw the same doctor on the same day, each patient gets their own form and a copy of the relevant bill.
Forgetting to sign.
Leaving the accidental injury section blank when services were accident-related.
Resubmitting the same claim before the 30-day window has passed.

If a claim is denied or processed in a way you disagree with, the EOB will include information about your appeal rights, and customer service at 800-627-1188 can walk you through the next steps.¹

Having Someone Else Handle the Claim

If you want a family member, attorney, or other person to manage claims or appeals on your behalf, Blue Cross of Idaho uses a separate Authorized Representative Form. The representative can be anyone you choose, including your doctor.⁷ If you are 18 or older, you must sign the authorization yourself unless a legal representative such as a power-of-attorney holder or court-appointed guardian is acting for you. Parents can sign for dependent children under 18 without additional paperwork; all other personal representatives need to attach a copy of the power of attorney or court order. Mail the form to the Grievances and Appeals Department at P.O. Box 7408, Boise, ID 83707, or fax it to 208-331-7493. Submitting the authorization alone does not start an appeal; your representative must also submit a separate written appeal.

1
Blue Cross of Idaho. Contact Blue Cross of Idaho
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Blue Cross of Idaho. Blue Cross of Idaho FAQs
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Blue Cross of Idaho. Blue Cross of Idaho Member Claim Form
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Blue Cross of Idaho. Blue Cross of Idaho Provider Portal – PAP 234 Coordination of Benefits
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Blue Cross of Idaho. New Member Website
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Blue Cross of Idaho. What Is an Explanation of Benefits
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Blue Cross of Idaho. Authorized Representative Form