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Instructions: 1. in the Left-Hand Column, Locate the State Where Services Were Rendered

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Instructions: 1. in the Left-Hand Column, Locate the State Where Services Were Rendered Instructions: 1. In the left-hand column, locate the state where services were rendered. 2. If services were rendered in New York or Pennsylvania, then use the state-specific file address PDF. 3. Lastly mail the completed claim form to the address provided. STATE MAIL TO MAILING ADDRESS CITY, STATE ZIP Alabama Blue Cross and Blue Shield of Alabama 450 Riverside Parkway E Birmingham, AL 35298 Alaska Premera Blue Cross of Washington & Alaska PO Box 91080 Seattle, WA 98111 Arizona BCBS of Arizona PO Box 2924 Phoenix, AZ 85062 Arkansas Arkansas Blue Cross Blue Shield PO Box 2181 Little Rock. AR 72203 California Wellpoint Health Networks (Blue Cross) PO Box 60007 Los Angeles, CA 90060 California Blue Shield of California PO Box 1505 Red Bluff, CA 96080 Colorado Anthem BCBS (Colorado) PO Box 173681 Denver, CO 80217 Connecticut Anthem Blue Cross Blue Shield PO Box 522 North Haven, CT 06473 Delaware Blue Cross Blue Shield of Delaware PO Box 1991 Wilmington, DE 19899 Florida Blue Cross Blue Shield of Florida PO Box 1798 Jacksonville, FL 32231 Georgia Blue Cross Blue Shield of Georgia PO Box 9907 Columbus, GA 31908 Hawaii HMSA -- BlueCard Department PO Box 2970 Honolulu, HI 96802 Idaho Blue Cross of Idaho 3000 E. Pine Ave. Meridian, ID 83642 Idaho Regence BlueShield of Idaho PO Box 31603 Salt Lake City, UT 84131 Illinois BlueCross BlueShield of Illinois PO Box 1364 Chicago, IL 60690 Indiana Anthem Blue Cross Blue Shield PO Box 31780 Louisville, KY 40233 Iowa Wellmark BCBS of Iowa 636 Grand Ave., Station 39 Des Moines, IA 50309 Kansas Blue Cross Blue Shield of Kansas PO Box 239 Topeka, KS 66629 Kentucky Anthem Blue Cross Blue Shield PO Box 31780 Louisville, KY 40233 Louisiana BCBS of Louisiana PO Box 98029 Baton Rouge, LA 70898 Maine Anthem Blue Cross and Blue Shield (Maine) 2 Gannett Drive South Portland, ME 04106 Maryland CareFirst BlueCross BlueShield 10455 Mill Run Circle Owings Mills, MD 21117 Massachusetts BCBS of Massachusetts PO Box 9209 North Quincy, MA 02171 Michigan Blue Cross Blue Shield of Michigan PO Box 5124 Southfield, MI 48036 Minnesota BCBS of Minnesota PO Box 64338 St. Paul, MN 55164 Mississippi Blue Cross Blue Shield of Mississippi PO Box 1043 Jackson, MS 39215 Missouri BCBS of Missouri 1831 Chestnut Street St. Louis, MO 63103 Missouri Blue Cross Blue Shield of Kansas City PO Box 419016 Kansas City, MO 64141 Montana Blue Cross and Blue Shield of Montana PO Box 5004 Great Falls, MT 59405 Nebraska BCBS Nebraska 7261 Mercy Road Omaha, NE 68180 Nevada Anthem BCBS (Nevada) PO Box 173681 Denver, CO 80217 New Hampshire Anthem BCBS of New Hampshire 3000 Goffs Falls Road Manchester, NH 03111 New Jersey Horizon Blue Cross Blue Shield of New Jersey PO Box 1219 Newark, NJ 07101 New Mexico BCBS of New Mexico PO Box 27630 Albuquerque, NM 87125 New York Based on Zip Code, See NY PDF for mailing address North Carolina BCBS of North Carolina PO Box 2291 Durham, NS 27702 North Dakota BCBS of North Dakota 4510 13th Ave. SW Fargo, ND 58121 Ohio Anthem Blue Cross Blue Shield PO Box 31780 Louisville, KY 40233 Oklahoma BCBS of Oklahoma PO Box 3283 Tulsa, OK 74102 Oregon Regence BCBS of Oregon PO Box 30805 Salt Lake City, UT 84130 Pennsylvania Based on Zip Code, See NY PDF for mailing address Rhode Island Blue Cross Blue Shield of Rhode Island 444 West Minster St. Providence, RI 02903 South Carolina Blue Cross Blue Shield of South Carolina PO Box 100300 Columbia, SC 29202 South Dakota Wellmark BCBS of South Dakota 1601 West Madison Sioux Falls, SD 57104 Tennessee BlueCross BlueShield of Tennessee PO Box 180150 Chattanooga, TN 37401 Texas BlueCross BlueShield of Texas PO Box 660044 Dallas, TX 75266-0044 Utah Regence BCBS of Utah PO Box 30270 Salt Lake City, UT 84130 Vermont BCBS of Vermont PO Box 186 Montpelier, VT 05602 Virginia Anthem BCBS of Virginia (formerly Trigon) PO Box 27401 Richmond, VA 23286 Washington Premera Blue Cross of Washington & Alaska PO Box 91080 Seattle, WA 98111 Washington DC CareFirst, Inc. 840 First Street NE Washington, DC 20002 West Virginia Mountain State BCBS 45 20th Street Wheeling, WV 26003 Wisconsin Blue Cross Blue Shield of Wisconsin PO Box 2270 Fond Du Lac, WI 54936 Wyoming Blue Cross & Blue Shield fo Wyoming PO Box 2266 Cheyenne, WY 82003 Rev 3/2007.
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