Claims Forms
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2008 Pharmacy Claim Form for PPO and Indemnity Members
BlueChoice Member Health Expense Report
BlueChoice Pharmacy Expense Form
UHC Health Claim Transmittal Form - Updated 2/18/08
Use this form for PPO, Indemnity and High Deductible Plan members for dates of services January 1, 2006 forward.
Lumenos Customer Medical Claim Form
Lumenos MedCo Pharmacy Expense Form
Kaiser Permanente
No claim form required. Submit itemized bill containing the member name and ID number to: Kaiser Permanente, Claims, P.O. Box 190849, Atlanta, GA 31119-0849
