Forms

BlueAdvantage and BlueAdvantagePlus Forms

Any of the forms below should be mailed or faxed to:

BlueCross BlueShield of Tennessee
Attn: BlueAdvantage Operations Appeals/Grievance Coordinator
P.O. Box 180205
Chattanooga, TN 37402
Fax: (423) 296-5498

pdf file Many of the publications on this site require the Adobe Acrobat Reader in order to view them.
  • Claim Form (0.3 MB)
    The majority of your claims will be submitted by your provider or pharmacy electronically, but should you need to file a paper claim, please use this form.
  • Grievance Form (0.1 MB)
    Use this form to file a complaint about plan policies or procedures
  • Appeals Form (0.1 MB)
    Use this form to file a complaint regarding denial of a claim or service.
  • Prescription Drug Coverage Determination Form (0.03 MB)
    Use this form to request a formulary exception, tiering exception, a prior authorization or reimbursement for a covered prescription drug claim.

Prior Authorization Forms
Use the appropriate form below to request prior authorization for the services listed below. These forms should be completed by your doctor.

Page Modified:May 18, 2012