Excellus BlueCross BlueShield

Source: https://www.excellusbcbs.com/documents/d/global/exc-medical-claim-form

Read date: 10-09-2026

Research steps

1. Confirm that the member plan includes an out-of-network benefit and that the claim is within 12 months after service under the published commercial PPO contract. https://member.excellusbcbs.com/documents/d/global/under-65-ppo-contract-with-rx
2. Sign in, choose Submit Claims, complete the on-screen claim form, and select Send to Us Electronically. https://www.excellusbcbs.com/contact/email
3. Prepare the provider's itemized bill with the member and provider details, credentials, tax identifier, NPI, service date, procedure or description, charge, diagnosis, and place of service listed on the downloadable form. https://www.excellusbcbs.com/documents/d/global/exc-medical-claim-form
4. If using the downloadable MSA-1fa form, complete it and sign the subscriber certification. NOT PUBLISHED: whether this PDF can be attached to the on-screen claim. https://www.excellusbcbs.com/documents/d/global/exc-medical-claim-form
5. Follow the signed-in prompts to submit. NOT PUBLISHED: claim-upload file types, file size, maximum file count, packaging rule, and confirmation. https://www.excellusbcbs.com/contact/email
6. Review claim history in the member account. The published commercial contract states a 30-day payment period for an electronic claim when the payment obligation is reasonably clear. https://member.excellusbcbs.com/documents/d/global/under-65-ppo-contract-with-rx

Filing facts

• Portal upload: YES
• Portal: Excellus BlueCross BlueShield member account
• Portal path: Log in > Submit Claims > complete claim form > Send to Us Electronically
• Mail address: Excellus BlueCross BlueShield, P.O. Box 21146, Eagan, MN 55121-0146
• Fax: NOT PUBLISHED
• Attach: member full name; birth field; provider name and address on letterhead; provider credentials; provider employer identification number; provider NPI; date of each service; procedure code or description for each charge; charge for each service; diagnosis code or illness or injury; place of service; country and English translation for care outside the United States; prescription information when applicable
• File types: NOT PUBLISHED for claim upload
• File size limit: NOT PUBLISHED
• Maximum files: NOT PUBLISHED
• One file or separate files: NOT PUBLISHED
• Confirmation: NOT PUBLISHED
• Status check: Member account > claim history
• Processing time: 30 days for an online or electronic claim when the payment obligation is reasonably clear; post-service determination within 30 calendar days
• Member deadline: 12 months from the date services were rendered
• Deadline basis: Published commercial PPO contract; controlling group or self-funded plan may differ
• Mental health route: Excellus BlueCross BlueShield behavioral health

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