Claim
Claim Form - Medical (FEP)
Federal Employee Program (FEP) members use this form to file a medical claim. ID: 10407
Claim Form - Medical - Reimbursement - Orally Administered Cancer Medication Coverage
Use this form to request reimbursement for cancer medication. ID: 5337
Dental - Patient Encounter Form
This is a Dental claim form used by the dental provider for patient encounters. ID: 2954
Prescription Drug Claim Form - Prime Therapeutics
Use this claim form for prescriptions filled by Prime Therapeutics. Prime Therapeutics LLC is an independent company providing pharmacy benefit management services for Horizon BCBSNJ members. ID: 3272