WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 85 Part 9 Filing a Claim When the Provider Files a Claim The health care provider will file a claim for you when you receive a covered service from a covered provider who has a payment agreement with Blue Cross Blue Shield HMO Blue. Or, for covered services you receive outside of Massachusetts, a health care provider will file a claim for you when they have a payment agreement with the local Blue Cross and/or Blue Shield Plan. Just tell the health care provider that you are a member and show the health care provider your ID card. Also, be sure to give the health care provider any other information that is needed to file your claim. You must properly inform your health care provider within 30 days after you receive the covered service. If you do not, coverage will not have to be provided. Blue Cross Blue Shield HMO Blue will pay the health care provider directly for covered services when the provider has a payment agreement with Blue Cross Blue Shield HMO Blue or with the local Blue Cross and/or Blue Shield Plan. (When you are outside the United States, Puerto Rico, and the U.S. Virgin Islands and the Blue Cross Blue Shield Global Core Service Center has arranged your inpatient admission, the hospital should file the claim for you. In this case, the hospital will usually bill you only for your deductible and/or your copayment and/or your coinsurance, whichever applies. But, if you paid the hospital’s actual charge in full at the time of the service, you must submit a claim as described in the section below.) When the Member Files a Claim You may have to file your claim when you receive a covered service from a covered provider who does not have a payment agreement with Blue Cross Blue Shield HMO Blue or a covered provider outside of Massachusetts who does not have a payment agreement with the local Blue Cross and/or Blue Shield Plan. The health care provider may ask you to pay the entire charge at the time of the visit or at a later time. It is up to you to pay your health care provider. To file a claim to Blue Cross Blue Shield HMO Blue for repayment, you must:  Fill out a claim form;  Attach your original itemized bills; and  Mail the claim to the Blue Cross Blue Shield HMO Blue customer service office. You can get claim forms from the Blue Cross Blue Shield HMO Blue customer service office. (See Part 1.) Blue Cross Blue Shield HMO Blue will mail to you all forms that you will need within 15 days after receiving notice that you obtained some service or supply for which you may be paid. When you receive covered services outside the United States, Puerto Rico, and the U.S. Virgin Islands, you must file your claim to the Blue Cross Blue Shield Global Core Service Center. (The Blue Cross Blue Shield Global Core Claim Form you receive from Blue Cross Blue Shield HMO Blue will include the address to mail your claim.) You can get help with filing your claim by calling the service center at 1-800-810-BLUE. You must file a claim within two years of the date you received the covered service. Blue Cross Blue Shield HMO Blue will not have to provide coverage for services and/or supplies for which a claim is submitted after this two-year period.