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Download a claim form for medical services,. Web download your claim form. This form serves as a remittance advice to assist in properly adjusting your account/claim with either. Blue cross and blue shield of texas. Attach copies of receipts/ proof of premium payment. Courier address (signature required) blue cross and blue shield of texas claims. Web a provider refund form must be submitted with your payment and remittance form to bcbsil, refund and recovery, p.o.