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Blue Advantage® Required CMS-1500 Fields

To receive a supply of the CMS-1500 forms, a provider can contact a forms vendor. Click here to view a chart that identifies the required fields that a provider must complete in order for the claim to process correctly. The numbers to the left of the chart correspond to those on the claim form. If one or more of the “required” fields are left blank or are incomplete, Blue Cross will return the claim (if paper) or deny it (if electronic).

The CMS-1500 Required Field Information chart provides basic filing instructions providers need to submit services for payment. Click here to download the CMS-1500 form.

Blue Advantage is a Medicare-approved PPO Plan.

Last Updated January 2014