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Appeals

• Blue Card Appeal Request Form
• Member Complaint/Grievance Form
• Member Authorization Form

Claim Forms

• Claims Inquiry Form (PDF)
• FEP Member Reimbursement Claim Form
• Itemized Bill Submission Form
• Medical/Dental Claim Form (PDF)
• Pharmacy Claim Form (PDF)
• BlueCard Worldwide International Claim Form
• Provider Out of Network Form

Little Stars Program Referral

• Little Stars® Physician Referral Form

Prior Authorization

• Submit or Review a Prior Authorization
• Federal Employee Advance Medical Review Forms

Provider Services

• Credentialing Application
• MA Waiver of Liability
• Provider Updates Form

Provider Electronic Funds Transfer

• Provider Electronic Funds Transfer Application Form (EFT)

Skilled Nursing Facility Concurrent Review

• Concurrent Review for Post-Acute Form

Utilization Management

• Inpatient Reviews