Ensure you are using the latest web browser version in order to submit electronic forms. The online form submission is not available to iOS devices (an operating system used for mobile devices manufactured by Apple). If you are using one of these devices please use the PDF to complete your form.
- 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
Little Stars Program Referral
- Provider Out of Network Form
- Provider Electronic Funds Transfer Application Form (EFT)
- MA Waiver of Liability
Skilled Nursing Facility Concurrent Review
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