Your session is about to expire

Your session will automatically expire in  seconds.

Skip Navigation Links

Submitting Claims

Members are encouraged to have their claims processed electronically at their pharmacy to ensure the best price.  However, if the pharmacy is unable to process electronically or you forgot your ID card, you can submit your claim directly to Prime using the following form:

       Prime Prescription Reimbursement Form

Note:  Use this form to request reimbursement when your drug benefit is processed directly through BCBSMT rather than through a third party Pharmacy Benefit Manager.

        Prescription Drug Claim Form- For Senior (Blue) Plan J, and Senior Care Golden members with prescriptions that were filled prior to December 31, 2013.  These forms are no longer being used for prescriptions that are filled after January 1, 2014. Use the Prime prescriptions reimbursement form (above) for prescriptions filled after January 1, 2014, or have your Prime participating pharmacy electronically submit the claims for you.

Linked In
Follow us on TwitterFind us on Facebook     A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield
     Association.   © Copyright 2013 Health Care Service Corporation. All Rights Reserved
Pharmacy Submitting Claims