Medical


Claim forms and claims-related forms.


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Medical Transition Care Benefit Request

Transition Care, also referred to as treatment in progress, is a benefit that allows new subscribers and covered dependents to receive medical care by non-participating providers at the in-network benefit level for treatment of an acute injury or illness. Transition care is short term and not intended to replace the regular provisions of the program.

ID: 7164 (W0312)


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SHBP/SEHBP Medical Claim Form

New Jersey State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members with NJ DIRECT should use this form to file claims.

ID: 2642 (0120)


Blue Cross Blue Shield Global Core Forms

If you need to file a claim for services provided outside of the United States, you can obtain the necessary forms from the Blue Cross Blue Shield Global Core website. Please have your ID prefix ready to enter before searching for your plan form.