Blue Shield of California

Source: https://www.blueshieldca.com/content/dam/bsca/en/broker/docs/2024/large-groups/CLM14850-SubscriberClaimForm-LOCKED.pdf

Read date: 10-09-2026

Research steps

1. Confirm that the plan covers the nonparticipating service. Blue Shield states that PPO members can use out-of-network providers, while an HMO generally does not cover out-of-network care without a referral except for emergency services. Claims payment policy
2. Complete Subscriber's Statement of Claim CLM14850-FF. Use a separate form for each member, provider, and itemized bill. Print or type, fill every item, answer the out-of-network self-referral question, and sign and date the subscriber certification. Subscriber's Statement of Claim
3. Attach the provider's itemized bill. NOT PUBLISHED: the current form and claim policy do not enumerate the service-line fields that the bill must contain. Subscriber's Statement of Claim Claims payment policy
4. Portal upload NO. The public form and QHP claim policy publish only an offline submission route. Destination details are excluded. The online account and app are published for claim status and EOB access, not claim upload. Subscriber's Statement of Claim Claims and costs
5. File within one year after the date of service under the published QHP rule. A complete QHP claim is processed within 30 business days. In the online account, open account page, Claims, then View claims; the EOB is also available in the account or mobile app. Claims payment policy Claims and costs EOB help
6. For services on or after January 1, 2026, Blue Shield lists mental health and substance use claims from participating and nonparticipating providers under the same Blue Shield claim form and route. Claims payment policy

Filing facts

• Portal upload: NO
• Portal: Blue Shield online account and mobile app
• Portal path: NOT APPLICABLE: the public claim form and QHP claim policy direct offline submission only
• Mail address: Blue Shield of California, P.O. Box 272540, Chico, CA 95927-2540
• Fax: NOT PUBLISHED
• Attach: NOT PUBLISHED: current claim form and QHP page require an itemized bill but do not enumerate its service-line fields
• File types: NOT APPLICABLE
• File size limit: NOT APPLICABLE
• Maximum files: NOT APPLICABLE
• One file or separate files: NOT APPLICABLE
• Confirmation: EOB after processing
• Status check: Online account > account page > Claims > View claims; EOB in account or mobile app
• Processing time: 30 business days when complete for QHP claims
• Member deadline: Within one year of date of service
• Deadline basis: Published QHP rule; employer plan document controls other products
• Mental health route: Blue Shield administers mental health and substance use claims for 2026 dates of service; same member claim form and route

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.