(Claims after 01/01/21).
Medical Claim Form
(Claims before 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
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)
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.
400 Plumas Blvd., Suite 210
Yuba City, CA 95991
© TRI-COUNTY SCHOOLS INSURANCE GROUP. ALL RIGHTS RESERVED.