FORMS LIBRARY This section will allow you to access forms for Premera Blue Cross.

 

 

Premera Blue Cross Forms
 
  • Premera Blue Cross - Waiver of Coverage Form
  • Premera Blue Cross - Domestic Partner Affidavit
  • Premera Blue Cross - Deductible Credit Form
  • Premera Blue Cross - Claim Form
 
Premera Blue Cross Claims and Billing Forms
 
  • Premera Blue Cross - Appeal Authorization Form
  • Premera Blue Cross - Appeals Submission Form - For Contracted Providers
  • Premera Blue Cross - Corrected Claim Cover Sheet
  • Premera Blue Cross - Incident Questionnaire
  • Premera Blue Cross - Massage Therapy Prescription Form
  • Premera Blue Cross - Massage Therapy Prescription Tip Sheet
  • Premera Blue Cross - Other Coverage Questionnaire Enrollment
  • Premera Blue Cross - Overpayment Notification Form
  • Premera Blue Cross - Request to Enable Real-Time Claims
  • Premera Blue Cross - Standard Provider Letter for Refunds Less Than $25
  • Premera Blue Cross - Support Document Cover Sheet
  • Premera Blue Cross - Request for Certification of Disabled Dependent
 
Premera Blue Cross Pharmacy Forms
 
  • Premera Blue Cross - Rx Claim Form
  • Premera Blue Cross - Home Delivery Form
  • Premera Blue Cross - Rx Formulary Exception Request Form
 
 

 

 

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