General Commercial Claims Forms

• Medical/Dental Claim Form
• Pharmacy Claim Form
• BlueCard Worldwide International Claim Form

General Prior Authorization Forms

• Services, Durable Medical Equipment (DME) and Prostheses requiring Prior Authorization
• Medications
• Prior Authorization for Medications - ACA (Affordable Care Act) Plans ONLY
• Federal Employee Advance Medical Review
• Predetermination Forms

Medicare Advantage Claims Forms

• MA Medical Reimbursement Request
• MA Dental Member Reimbursement Request
• MA World Wide Emergency Service
• MA Part D Pharmacy Medications Claim Form