Documents & Forms Results

Eyewear Reimbursement Form (Medicare)

Request reimbursement for eligible eye care services you've received. For members of Medicare plans.

Vision Direct Reimbursement Claim Form

Blue Plus Member Appeal Rights Process

Appeals process for the following plans: Blue Advantage Families and Children, MinnesotaCare and Minnesota Senior Care Plus (MSC+)

Blue Plus Member Authorization form

BCBS and Blue Plus Fully Insured Complaint Form

BCBS Fully Insured Complaint Form

Blue Cross and Blue Shield of Minnesota Self-Insured Complaint Form

Privacy Practices Complaint Form

Non-Minnesota/Non-Par Provider Claim Adjustment Appeal Form

International Claim Form

For Blue Cross Blue Shield Global Solutions (formerly GeoBlue) members (Note: Medicare members should use the Worldwide Emergency or Urgent Care Benefit Claim Form).