Anthem Pre-Paid Claim Form

If your provider does not submit to Anthem on your behalf, you will have to complete this Medical/Vision claim form and file directly to Anthem. This includes claims you have already paid in advance.

  1. This form must be completed by you.
  2. Attach an itemized bill (See Anthem's form on what is an acceptable itemized bill).
  3. You must send this claim to the Local Blue Cross/Blue Shield address for the state you live in.
  4. Please keep a copy for your records and the date that it was sent to Anthem.

PLEASE BE ADVISED: Claims must be processed through all insurances before filing for reimbursement out of your flexible reimbursement account.