For Patients

Notice of Privacy Practices
Payment Options
Major Insurance Plans
Forms
FAQs
Contact Us

Forms

For your convenience, below are some forms that our Customer Service Representatives might need you to print, sign and return via postal service or email to better service your insurance claim.

Simply click the link and the form will come up in Adobe Reader with the ability to print. Some of the forms you will be able to fill out using Adobe Reader so all you have to do is print and sign.

Blue Cross Blue Shield of Arizona Health Coverage Appeal Request Form
Blue Cross Blue Shield of Arizona Provider Appeal and Grievance Quick Reference Guide
Blue Cross Blue Shield of Arizona Provider Certification Form for Expedited Medical Review
Blue Cross Blue Shield of Arizona Provider Grievance Form
Blue Cross Blue Shield of California Formulario de Quejas Para Miembros
Blue Cross of California Member Grievance Form
HIPAA Authorization Form
Medical Records Release Form

Download Free Adobe Reader

Our documents and forms are available in Adobe Acrobat (PDF) format. If you do not have Acrobat Reader, or a similar product to view the forms, please click on the link below.