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Next, choose submit a claim online. (form bc420) change form for first choice. Log in to my account and select the claims tab. Web health benefits claim form. If you use a provider outside of the network, you will need to complete and file a claim form for reimbursement. Important notes when completing the claim. If we need more information, we will attempt to reach you by phone and email. Web pay me back claim form • print or write legibly. • do not use a fax cover sheet. Web claim forms, submissions, responses and adjustments.
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