Florida Blue (BCBS of Florida, GuideWell)

Source: https://files.guidewell.com/m/1fa165f287783090/original/member-forms-claim-medical-eng.pdf

Read date: 10-09-2026

Research steps

1. Confirm that the service was not submitted by the provider and is eligible for member filing. The form says it is for services and supplies not submitted by the provider, including out-of-network doctors and hospitals. Medical Claim Form
2. Complete every section of Medical Claim Form 68422-0425, using a separate form for each family member and each physician or supplier. Sign the required policyholder certification. Leave the optional Authorization of Payment to Non-Contracted Providers unsigned if the member does not want to request direct provider payment. Medical Claim Form
3. Attach the original itemized bill or receipt. A superbill may be used when it contains every item listed in the form instructions. Attach other coverage EOBs when applicable. Medical Claim Form
4. Portal upload NO. The public form publishes only an offline submission route. No member portal or app claim-upload path is published. Do not attempt to infer an upload path from My Claims, which the public help text describes for finding forms and viewing claims. Claims help Medical Claim Form
5. Check claim status in the member account under My Claims or Claims & Expenses and review the monthly Member Health Statement. Claims help Claims and Health Statements FAQ

Filing facts

• Portal upload: NO
• Portal: FloridaBlue.com member account
• Portal path: NOT APPLICABLE: public claim form directs mail submission only
• Mail address: Florida Blue, P.O. Box 1798, Jacksonville, FL 32231-0014
• Fax: NOT PUBLISHED
• Attach: Physician or supplier name; physician or supplier address; Tax ID; NPI; member name; patient's full name if different; type of service; procedure code; date of service or purchase; diagnosis; diagnosis code; condition being treated; charge for each service
• File types: NOT APPLICABLE
• File size limit: NOT APPLICABLE
• Maximum files: NOT APPLICABLE
• One file or separate files: NOT APPLICABLE
• Confirmation: NOT PUBLISHED
• Status check: FloridaBlue.com member account, My Claims or Claims & Expenses; monthly Member Health Statement
• Processing time: NOT PUBLISHED
• Member deadline: Within one year from date of service
• Deadline basis: Individual ACA post-service claims are due within 90 days when reasonably possible and never later than one year; other plan documents may differ
• Mental health route: Lucet is the behavioral health care administrator; no different member claim route 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.