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Independence Blue Cross (IBX) fax number

(215) 241-2042

Member Correspondence

Used for: Authorization to Disclose Health Information

Fax destination details

Department
Member Correspondence
Purpose
Authorization to Disclose Health Information
Form
Authorization to Disclose Health Information — Authorization to Disclose Health Information Form
Address
P.O. Box 41890, Philadelphia, PA 19101-1890

Before you send

  • Confirm that this exact department handles your document or request.
  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Fill in member information, indicate the recipient, choose the information to be released, sign and date, and return to Member Correspondence. Fax the completed form to 215-241-2042 or mail it to P.O. Box 41890, Philadelphia, PA 19101-1890.

Official form instructions are published as a downloadable file on the organization's website.

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