Anthem International Claim Form

This form is used to submit institutional and professional claims for benefits for covered services received outside the United States, Puerto Rico, and the U.S. Virgin Islands. Each provider’s original itemized bill must be attached. For other claim types (e.g., dental, prescription drugs) contact your Blue Cross and Blue Sheild Company for filing instructions.

The form and proper documentation can be submitted to BlueCross BlueShield Global Core in the following ways:

1. Mail: Service Center, P.O. Box 2048, Southeastern, PA 19399
2. Online at www.bcbsglobalcore.com
3. Email: claims@bcbsglobalcore.com

https://www.anthem.com/content/dam/digital/docs/employer/forms/claims/16-581-N35.pdf