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Claims Resources and Guides

General Information

  • Claims Requiring Submission of Clinical Information
  • Claims Submission Addresses
  • Clinical Relationship Logic
  • NDC Code Submission
  • Referral Submission Rules

Provider User Guides

  • PDF icon CMS-1500 claims submission toolkit
  • PDF icon UB-04 claims submission guide
  • PDF icon Facility SOR Guide (for non-migrated members only)
  • PDF icon Professional SOR Guides (for non-migrated members only)
  • Chiropractic Billing Guide

Provider Appeals and Disputes

  • PDF icon Independence’s post-service appeals and grievance processes

Medicare Advantage Members

  • PDF icon Medicare Payment Dispute Process for Non-Contracted Providers
  • PDF icon Medicare Provider Appeals Process for Non-Contracted Providers
  • PDF icon Payment Dispute Decision Request Form
  • PDF icon Waiver of Liability Statement

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© Independence Blue Cross.
Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.