Blue Cross Provider Dispute Form - Web mail the completed form to: Web send this form and supporting documents to: Complete this form to file a provider dispute. Healthy blue provider dispute unit mail code: Web this form is for all providers requesting information about claims status or disputing a claim with blue cross and blue shield of illinois (bcbsil) and serving members in. Claims for certain services may be eligible for payment review under the. This form must be included with your request to ensure that it is routed to the appropriate area of the.
Claims for certain services may be eligible for payment review under the. Web mail the completed form to: Complete this form to file a provider dispute. Healthy blue provider dispute unit mail code: Web this form is for all providers requesting information about claims status or disputing a claim with blue cross and blue shield of illinois (bcbsil) and serving members in. This form must be included with your request to ensure that it is routed to the appropriate area of the. Web send this form and supporting documents to: