STATE MAIL TO MAILING ADDRESS CITY, STATE ZIP

1 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 TOMAILING ADDRESSCITY, STATE ZIPA labamaBlue Cross and Blue Shield of Alabama450 Riverside Parkway EBirmingham, AL 35298 AlaskaPremera Blue Cross of Washington & AlaskaPO Box 91080 Seattle, WA 98111 ArizonaBCBS of ArizonaPO Box 2924 Phoenix, AZ 85062 ArkansasArkansas Blue Cross Blue ShieldPO Box 2181 Little Rock. AR 72203 CaliforniaWellpoint Health Networks (Blue Cross)PO Box 60007 Los Angeles, CA 90060 CaliforniaBlue Shield of CaliforniaPO Box 1505 Red Bluff, CA 96080 ColoradoAnthem BCBS (Colorado)PO Box 173681 Denver, CO 80217 ConnecticutAnthem Blue Cross Blue ShieldPO Box 522 North Haven, CT 06473 DelawareBlue Cross Blue Shield of DelawarePO Box 1991 Wilmington, DE 19899 FloridaBlue Cross Blue Shield of FloridaPO Box 1798 Jacksonville, FL 32231 GeorgiaBlue Cross Blue Shield of GeorgiaPO Box 9907 Columbus, GA 31908 HawaiiHMSA -- BlueCard DepartmentPO Box 2970 Honolulu, HI 96802 IdahoBlue Cross of Idaho3000 E.

2 Pine , ID 83642 IdahoRegence BlueShield of IdahoPO Box 31603 Salt Lake city , UT 84131 IllinoisBlueCross BlueShield of IllinoisPO Box 1364 Chicago, IL 60690 IndianaAnthem Blue Cross Blue ShieldPO Box 31780 Louisville, KY 40233 IowaWellmark BCBS of Iowa636 Grand Ave., Station 39 Des Moines, IA 50309 KansasBlue Cross Blue Shield of KansasPO Box 239 Topeka, KS 66629 KentuckyAnthem Blue Cross Blue ShieldPO Box 31780 Louisville, KY 40233 LouisianaBCBS of LouisianaPO Box 98029 Baton Rouge, LA 70898 MaineAnthem Blue Cross and Blue Shield (Maine)2 Gannett DriveSouth Portland, ME 04106 MarylandCareFirst BlueCross BlueShield10455 Mill Run CircleOwings Mills, MD 21117 MassachusettsBCBS of MassachusettsPO Box 9209 North Quincy, MA 02171 MichiganBlue Cross Blue Shield of MichiganPO Box 5124 Southfield, MI 48036 MinnesotaBCBS of MinnesotaPO Box 64338St.

3 Paul, MN 55164 MississippiBlue Cross Blue Shield of MississippiPO Box 1043 Jackson, MS 39215 MissouriBCBS of Missouri1831 Chestnut StreetSt. Louis, MO 63103 MissouriBlue Cross Blue Shield of Kansas CityPO Box 419016 Kansas city , MO 64141 MontanaBlue Cross and Blue Shield of MontanaPO Box 5004 Great Falls, MT 59405 NebraskaBCBS Nebraska7261 Mercy RoadOmaha, NE 68180 NevadaAnthem BCBS (Nevada)PO Box 173681 Denver, CO 80217 New HampshireAnthem BCBS of New Hampshire3000 Goffs Falls RoadManchester, NH 03111 New JerseyHorizon Blue Cross Blue Shield of New JerseyPO Box 1219 Newark, NJ 07101 New MexicoBCBS of New MexicoPO Box 27630 Albuquerque, NM 87125 New YorkNorth CarolinaBCBS of North CarolinaPO Box 2291 Durham, NS 27702 North DakotaBCBS of North Dakota4510 13th Ave. SWFargo, ND 58121 OhioAnthem Blue Cross Blue ShieldPO Box 31780 Louisville, KY 40233 OklahomaBCBS of OklahomaPO Box 3283 Tulsa, OK 74102 OregonRegence BCBS of OregonPO Box 30805 Salt Lake city , UT 84130 PennsylvaniaRhode IslandBlue Cross Blue Shield of Rhode Island444 West Minster , RI 02903 South CarolinaBlue Cross Blue Shield of South CarolinaPO Box 100300 Columbia, SC 29202 South DakotaWellmark BCBS of South Dakota1601 West MadisonSioux Falls, SD 57104 TennesseeBlueCross BlueShield of TennesseePO Box 180150 Chattanooga, TN 37401 TexasBlueCross BlueShield of TexasPO Box 660044 Dallas, TX 75266-0044 UtahRegence BCBS of UtahPO Box 30270 Salt Lake city , UT 84130 VermontBCBS of VermontPO Box 186 Montpelier, VT 05602 VirginiaAnthem BCBS of Virginia (formerly Trigon)

4 PO Box 27401 Richmond, VA 23286 WashingtonPremera Blue Cross of Washington & AlaskaPO Box 91080 Seattle, WA 98111 Washington DCCareFirst, First Street NEWashington, DC 20002 West VirginiaMountain STATE BCBS45 20th StreetWheeling, WV 26003 WisconsinBlue Cross Blue Shield of WisconsinPO Box 2270 Fond Du Lac, WI 54936 WyomingBlue Cross & Blue Shield fo WyomingPO Box 2266 Cheyenne, WY 82003 Based on Zip Code, See NY PDF for MAILING addressBased on Zip Code, See NY PDF for MAILING addressRev 3/2007