Capital blue cross provider claims mailing address

Capital BlueCross is a Pennsylvania health plan headquartered in the capital city of Harrisburg. An independent licensee of the BlueCross BlueShield Association, Capital BlueCross serves almost 1 million people in 21 central and Lehigh Valley counties. The health network offers service from more than 18,000 providers and 40 hospitals.

Residents in the Capital BlueCross service area have access to individual and family health insurance, including Preferred Provider Organization (PPO) options both on and off the exchange.

Capital BlueCross also provides health insurance and related products through its subsidiaries, which include Capital Advantage Assurance Company®, Capital Advantage Insurance Company,® and Keystone Health Plan® Central.
The history of the company dates back to the 1930s, with the formation of Easton Hospital Association and Capital Hospital Service. In 1985, the organizations merged, forming Capital BlueCross.

Capital BlueCross has achieved many recognitions. These honors include being named to the “Who’s Who in Business Lehigh Valley” list, the “People’s Choice Who’s Who in Business Berks County” list, and the “Simply the Best” list through Harrisburg Magazine. The company has also earned the Women’s Leadership Award from the YWCA of Bethlehem.

Capital BlueCross supports community initiatives. The company raised over $40,000 for the Big Brothers and Big Sisters organization and supports additional causes, such as the Juvenile Diabetes Research Foundation, Leukemia and Lymphoma Society, and the American Heart Association.

Like many insurance companies, Capital BlueCross’s product offerings include PPO plans.

Explore Capital BlueCross with HealthMarkets today!

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Your health insurance claims

When you see a doctor or other health care provider, the provider’s office sends us a claim. The claim includes information on what treatments, tests or other services you received. The claims process is how we determine how much the plan pays and how much you may owe.

We process the claim based on the terms of your specific benefit plan including:

• Your coverage — Is the service included in your benefits? Was it medically necessary? Were any applicable referrals or authorizations in place?
• The allowed amount — We set negotiated rates with network providers. And we process claims based on these amounts.
• Your deductible — This is a set amount you must pay your providers before the plan begins to pay a portion.
• Your coinsurance rate — Once you meet your deductible, the plan generally pays a percentage of the cost. You’re responsible for the remaining amount. For example, the plan may pay 80 percent, while you would pay 20 percent.
• Your out-of-pocket maximum — If you’ve reached your out-of-pocket limit for the benefit year, your plan pays the full allowed amount.

Once we process a claim, we share this information with you in a statement called an Explanation of Benefits, or EOB.

Want to check the status of a pending claim? Or would you like to review your EOBs? With My Health Toolkit®, you can always access secure information about your claims — any time, from anywhere. Log into to the secure site or download the free mobile app from the App Store or Google Play.

Claim forms are for claims processed by Capital Blue Cross within our 21-county service area in Central Pennsylvania and Lehigh Valley. If you receive services outside Capital Blue Cross' 21-county area, another Blue Plan may have an agreement to process your claims, even though your coverage is with Capital Blue Cross. You should obtain claim forms from the local Blue Plan that processes your claims. The Capital Blue Cross service area includes these counties: Adams, Berks, Centre County, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union and York.

Claim forms are for claims processed by Capital Blue Cross within our 21-county service area in Central Pennsylvania and Lehigh Valley. If you receive services outside Capital Blue Cross' 21-county area, another Blue Plan may have an agreement to process your claims, even though your coverage is with Capital Blue Cross. You should obtain claim forms from the local Blue Plan that processes your claims. The Capital Blue Cross service area includes these counties: Adams, Berks, Centre County, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union and York.