MyBlue offers online tools, resources and services for Blue Cross Blue Shield of Arizona Members, contracted brokers/consultants, healthcare professionals, and group benefit administrators. 24/7 online access to account transactions and other useful resources, help to ensure that your account information is available to you any time of the day or night.
How to Complete Your Out-of-Network Claim Form Medical Claim Dental Claim BlueDental Prevention +1 Submission Form Pharmacy Claim Pharmacy Compounded Medication Claim
Customers Age 65 and older
Transporting & Lodging Benefit
Instructional PDF for Machine Readable Files BCBSAZ Machine Readable Files American Specialty Health Machine Readable Files Davis Vision Machine Readable Files
Mental Health Parity Disclosure Request Form
Your Rights and Protections Against Surprise Medical Bills Your Rights and Protections Against Surprise Medical Bills in Spanish
Member precertification list
Customers Over the Age of 65 QHP Rate Information 2020 BCBSAZ Rate Justification
PPO Members
Autopay Authorization
Accounting Request Form Amendment Request Authorized Representative Designation Form BCBSAZ Confidential Information Release BCBSAZ Confidential Information Release in Spanish BCBSAZ Confidential Information Release - HIV Related Information BCBSAZ Confidential Information Release - HIV Related in Spanish Confidential Communications Form HIPAA Notice of Privacy Practices Optum Pharmacy Confidential Information Release Form PHI Access Request Form Privacy Complaint Form Restriction Request Form
*Confidential Information Release Forms alone do not grant authorization to your representative to file appeals on your behalf. If you wish to have someone request an appeal on your behalf please submit a completed Confidential Information Release Form along with either an Authorized Representative Designation Form or Healthcare Power of Attorney. For more information on which form to use, visit the “What Form Should I Use?” tab to the right.
