INSURER FILING GUIDE
Anthem Blue Cross Blue Shield, Empire (New York)
Use this public information to prepare your packet, then confirm the route on the insurer's own page.
AT A GLANCE
Claim facts
| Member form | |
|---|---|
| Portal upload | YES |
| Portal path | Log in > Submit & Track Claims > submit out-of-network claims online |
| Mail address | Anthem Blue Cross and Blue Shield, P.O. Box 1407, Church Street Station, New York, New York 10008-1407 |
| Fax | Not published by the insurer |
| Attachments | Provider name; provider address; provider Tax ID; patient name; service provided; date of service; place of service; amount charged for each service; diagnosis code; procedure code |
| Deadline | Not published by the insurer: the claim form directs the member to the certificate of coverage |
| Outcome and status | Anthem account > Claims; Sydney Health app; EOB after processing |
| Processing time | Not published by the insurer |
| Caveats | HMO or EPO may not cover routine out-of-network care; account upload eligibility and mechanics can be plan-specific; Medicare Advantage and Medicaid are outside this row |
STEP BY STEP
Filing steps
Read date: 10-09-2026
Research steps
- Confirm that the member's plan includes out-of-network benefits. HMO, EPO, fully insured, and self-funded terms can differ. Anthem New York
- Complete Member Medical Claim Form 114027NYMENABS. Complete all areas, use a separate form for each member, and provide both required signatures and dates in section 7. Member Medical Claim Form
- Attach the itemized bill. It must contain the provider name, address, and Tax ID; patient name; service; date and place of service; charge for each service; diagnosis code; and procedure code. Member Medical Claim Form
- Log in, open Submit & Track Claims, and select the online out-of-network claim submission. Portal upload YES. UNREADABLE: the signed-in form, attachment types, size limit, file count, grouping, and confirmation. Anthem New York
- NOT PUBLISHED: a universal numeric deadline. The form directs the member to the certificate of coverage. Check the account Claims area or Sydney Health for status and EOBs. NOT PUBLISHED: commercial member-claim processing time. Member Medical Claim Form Anthem claims
- Anthem states that behavioral health benefits are integrated into its medical plans, but a different public member self-file portal is NOT PUBLISHED. Anthem New York behavioral health
Filing facts
- Portal upload: YES
- Portal: Anthem online account
- Portal path: Log in > Submit & Track Claims > submit out-of-network claims online
- Mail address: Anthem Blue Cross and Blue Shield, P.O. Box 1407, Church Street Station, New York, New York 10008-1407
- Fax: NOT PUBLISHED
- Attach: Provider name; provider address; provider Tax ID; patient name; service provided; date of service; place of service; amount charged for each service; diagnosis code; procedure code
- File types: NOT PUBLISHED
- File size limit: NOT PUBLISHED
- Maximum files: NOT PUBLISHED
- One file or separate files: NOT PUBLISHED
- Confirmation: NOT PUBLISHED
- Status check: Anthem account > Claims; Sydney Health app; EOB after processing
- Processing time: NOT PUBLISHED
- Member deadline: NOT PUBLISHED: the claim form directs the member to the certificate of coverage
- Deadline basis: Fully insured and self-funded plan deadlines are plan-specific
- Mental health route: Behavioral health benefits are integrated into Anthem medical plans; no distinct member self-file portal is published
Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.
Read on 10-09-2026 from https://www.anthembluecross.com/content/dam/digital/docs/anthembluecross/employer/forms/claims/114027NYMENEBS.pdf. Confirm the address, fax number or portal path on the insurer's own claims page before you send.