Forms

(Claims after 01/01/21).

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.

 

JPA Delegate Forms

PhysMetrics (formerly ChiroMetrics)

Complete the claim form and submit it to:

ProAct Inc.

1230 US HWY 11

Gouverneur, NY 13642

Attn: DMR Dept.

 

 

Costco Mail Order Pharmacy

215 Deininger Circle

Corona, CA  92880-9911

Our Mission is to pool risk and purchasing power of public entities to provide quality programs to our participants in an effective manner while emphasizing customer satisfaction, stability, financial solvency and cost.

530-822-5299
400 Plumas Blvd., Suite 210

Yuba City, CA 95991

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