Independence Blue Cross (Pennsylvania)

Source: https://www.ibx.com/pdfs/resources/for-members/medical-claim-form.pdf

Read date: 10-09-2026

Research steps

1. Log in at ibx.com. From Plan Selection choose the current plan, then choose View My Claims on QuickStart. https://healthinsurancehosting.com/edge-articles/wp-content/uploads/ibx-how-to-submit-out-of-network-claim-form-member-flyer.pdf
2. On Claims and Finances, choose Submit a New Claim, then Continue. https://healthinsurancehosting.com/edge-articles/wp-content/uploads/ibx-how-to-submit-out-of-network-claim-form-member-flyer.pdf
3. Under Choose a Form, choose Medical, then Next, then Complete Online Form. https://healthinsurancehosting.com/edge-articles/wp-content/uploads/ibx-how-to-submit-out-of-network-claim-form-member-flyer.pdf
4. Complete the Manual Claims Submission questionnaire and attach supporting documents. The provider bill must include diagnosis codes, procedure codes, and service costs. File types, size limit, maximum files, and PDF packaging rule are NOT PUBLISHED. https://healthinsurancehosting.com/edge-articles/wp-content/uploads/ibx-how-to-submit-out-of-network-claim-form-member-flyer.pdf
5. Choose Review, complete the Acknowledgement, and choose Submit. The acknowledgment wording and submission confirmation are UNREADABLE behind login. https://healthinsurancehosting.com/edge-articles/wp-content/uploads/ibx-how-to-submit-out-of-network-claim-form-member-flyer.pdf
6. Alternative: download and complete Medical Claim Form 2014-1619 (3/14), then in the same workflow choose Upload Claim Form, complete the questionnaire, attach supporting documents, and submit. https://www.ibx.com/pdfs/resources/for-members/medical-claim-form.pdf and https://healthinsurancehosting.com/edge-articles/wp-content/uploads/ibx-how-to-submit-out-of-network-claim-form-member-flyer.pdf
7. Check status through the online account's View claims route. Processing time is NOT PUBLISHED. https://www.ibx.com/resources/for-members/index.html

Filing facts

• Portal upload: YES
• Portal: IBX member portal
• Portal path: Plan Selection > current health plan > QuickStart > View My Claims > Claims and Finances > Submit a New Claim > Continue > Medical > Next > Complete Online Form; alternative Upload Claim Form
• Mail address: Claims Receipt Center, P.O. Box 211184, Eagan, MN 55121
• Fax: NOT PUBLISHED
• Attach: Diagnosis codes; procedure codes; costs for services; PDF form also asks diagnosis; dates; place of service; procedure description and code; diagnosis pointer; charges; units; paid and balance amounts; provider name and address and provider number
• File types: NOT PUBLISHED
• File size limit: NOT PUBLISHED
• Maximum files: NOT PUBLISHED
• One file or separate files: Supporting documents may be attached; whether one PDF or separate files is expected is NOT PUBLISHED
• Confirmation: NOT PUBLISHED
• Status check: IBX online account > View claims
• Processing time: NOT PUBLISHED
• Member deadline: Sample Personal Choice contract: notice within 20 days after completed services and no later than 12 months after the end of the benefit period
• Deadline basis: YES: HMO and employer or self-funded contracts can differ
• Mental health route: NOT PUBLISHED: no separate outpatient psychotherapy upload route found

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