For reimbursement complete items 1-11 of the claim form, attach receipt(s) and submit to:
FOR CLAIMS IN CALIFORNIA
Anthem Blue Cross of California
PO Box 60007
Los Angeles, CA 90060-0007
FOR CLAIMS OUTSIDE OF CALIFORNIA
Anthem Blue Cross/Blue Shield of the state the medical services were performed. If you have questions, call 800-810-BLUE(2583).
If you need the provider reimbursed then also sign item 12 and following the same procedures listed above. One claim form per patient.
PhysMetrics (formerly ChiroMetrics)
Complete the claim form and submit it to:
1230 US HWY 11
Gouverneur, NY 13642
Attn: DMR Dept.
Costco Mail Order Pharmacy
215 Deininger Circle
Corona, CA 92880-9911
Property Casualty Forms
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