Medical Claim Forms
Instructions
Complete all fields and return signed form to:
Blue Cross and Blue Shield of Texas P.O. Box 660044 Dallas, Texas 75266-0044
Fax: 312-946-354 | Phone: 866-355-5999
Click the button to open and download the form
For additional information & forms, you can also visit www.bcbstx.com/trsactivecare.