This drug must NOT be billed as an outpatient hospital facility place of service. Blue Card 816-395-3860. * If yes, why? This information is used by our development staff to address issues you may have found while filling in our various electronic forms. It is on the front of your Member ID card. Follow these instructions to activate and enable JavaScript in Chrome. Choose a file or files to attach (File types accepted: jpg, txt, doc, docx, pdf, xls, xlsx, ppt, pptx, rtf, tiff, and tif) To upload multiple files, hold down the CTRL key WebClaims Prior Authorization Resources Medical Policies Account Forms Ensure you are using the latest web browser version in order to submit electronic forms. An independent licensee of the Blue Cross and Blue Shield Associationdocument.write(new Date().getFullYear()) Blue Cross and Blue Shield of Kansas City. Follow these instructions to activate and enable JavaScript in Chrome. See the sample ID card above. IMPORTANT: If you are an FEP Member, enter "NA" into the Prefix field. To ensure the proper functionality of electronic forms you must have JavaScript enabled and be using a current version of your browser. Your feedback is greatly appreciated. IMPORTANT: If you are an FEP Member, enter "NA" into the Prefix field. Select your browser type and follow these instructions to activate and enable JavaScript or contact your administrator if you continue to experience issues. Blue KC Commercial Prior Authorization and Notification List Site of Care Authorization Your member ID is a unique number that identifies your plan. Prior Auth Log-In Quick Reference Follow these instructions to activate and enable JavaScript in Internet Explorer. Choose a file or files to attach (File types accepted: jpg, txt, doc, docx, pdf, xls, xlsx, ppt, pptx, rtf, tiff, and tif). Follow these instructions to activate and enable JavaScript in Firefox. Note that not filling in required fields (Marked with an *) will cause your submission to be rejected. Webproviders may continue submitting pre-determination requests for Federal Employee Program (FEP) and Joint Administrative Account (JAA) lines of business. Pharmacy Services If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842. To ensure the proper functionality of electronic forms you must have JavaScript enabled and be using a current version of your browser. All rights reserved. Enrol now. Submitting this feedback form does not include a submission of your form request. Box 412735 Credentialing Status. Or mail to: UseSpecial Authority eFormsto submit requests. Webbcbs kc inquiry form. P.O. To ensure the proper functionality of electronic forms you must have JavaScript enabled and be using a current version of your browser. Follow these instructions to activate and enable JavaScript in Opera. WebWe empower providers in our networks to improve care delivery for you. Your member ID is a unique number that identifies your plan. Your feedback is greatly appreciated. Medications Codes must be 3 - 8 characters and 2 decimals. If you can't find theform you need below, search for the drug in theSpecial Authority drugslist. Follow these instructions to activate and enable JavaScript in Safari. If you experience issues submitting this form, please print and fax it to (816) 817-8211. With tools and actionable data to support more coordinated, targeted care, you can reduce unnecessary Copy the following then paste it into the Firefox address bar: To the right of the address bar, click the icon with. See the sample ID card above. If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842. See the sample ID card above. Follow these instructions to activate and enable JavaScript on your Android. For Blue Card members, suffix is not required. Blue Cross and Blue Shield of Kansas City All rights reserved. IMPORTANT: If you are an FEP Member, enter "NA" into the Prefix field. Thank you. *, Choose a file or files to attach (File types accepted: jpg, txt, doc, docx, pdf, xls, xlsx, ppt, pptx, rtf, tiff, and tif). WebCheck the initial credentialing status for new providers. Kansas City, MO 64141-2735. Follow these instructions to activate and enable JavaScript on your Android. Prior Authorization Changes for Blue Cross and Blue Shield of Follow these instructions to activate and enable JavaScript in Firefox. WebIf you are using one of these devices please use the PDF to complete your form. Blue KC will provide coverage for Sleep Studies when it is determined to be medically necessary. Open a new Firefox browser window or tab. Follow these instructions to activate and enable JavaScript in Internet Explorer. FEP 816-395-3811. If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842. bcbs of kansas prior authorization forms. Providers may continue to submit pre-determinations for Federal Employee See the sample ID card above. Agents & Providers - Blue Cross and Blue Shield of Kansas City Your prefix is on the front of your Member ID card. Submitting this feedback form does not include a submission of your form request. Follow these instructions to activate and enable JavaScript in Chrome. If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842. Incomplete forms will not be processed. If you experience issues submitting this form, please try again later. You can access the e Note that not filling in required fields (Marked with an *) will cause your submission to be rejected. Your Suffix is a two digit number located on your Member ID card. Prior Authorizations Forms Special Authority requests must be completed by a licensed medical prescriber. An independent licensee of the Blue Cross and Blue Shield Associationdocument.write(new Date().getFullYear()) Blue Cross and Blue Shield of Kansas City. Prior Authorization Other Specialty Medications Your Suffix is a two digit number located on your Member ID card. eForms areeasier to submit and return decisions quicker than faxing paper forms. WebAll new-to-market medications will require a Prior Authorization. Special Authority requests must be completed by a licensed medical prescriber. WebFor providers who would like to continue submitting Prior Authorization requests through Blue KC's eForms (until the 1/1/2021 date), use the eForm pages listed below: Prior See the sample ID card above. Questions about the collection of information can be directed to the Manager of Corporate Web, Government Digital Experience Division. Thank you. If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842. Select your browser type and follow these instructions to activate and enable JavaScript or contact your administrator if you continue to experience issues. Select your browser type and follow these instructions to activate and enable JavaScript or contact your administrator if you continue to experience issues. Checking this box will send a copy of your form to the email address provided. If you experience issues submitting this form, please try again later. Diagnosis Codes must be 3-8 characters along with decimals. Is this a CPAP titration/re-titration? Hepatitis C: asunaprevir, daclatasvir, ledipasvir-sofosbuvir, pegylated interferon plus ribavirin, simeprevir, sofosbuvir, velpatasvir-sofosbuvir, sofosbuvir-velpatasvir-voxilaprevir, glecaprevir-pibrentasvir, alemtuzurnab, cladribine, dimethyl fumarate, fingolimod, glatiramer, interferon beta, natalizumab, ocrelizumab, rituximab, siponimod, teriflunomide, aclidinium, aclidinium/formoterol, glycopyrronium,glycopyrronium/indacaterol,indacaterol, salmeterol, salmeterol/ fluticasone, tiotropium 18 mcg, tiotropium/olodaterol, umeclidinium/vilanterol, umeclidinium/vilanterol/ fluticasone, vilanterol/fluticasone, benralizumab, mepolizumab, nintedanib, pirfenidone, adalimumab, etanercept, infliximab, secukinumab, ustekinumab, ixekizumab, dalteparin, enoxaparin, nadroparin, tinzaparin, *Don't provide personal information . WebIf you experience issues submitting this form, please print and fax it to one of the following: Local HMO/PPO 816-278-1944. Choose a file or files to attach * (File types accepted: jpg, txt, doc, docx, pdf, xls, xlsx, ppt, pptx, rtf, tiff, and tif). eForms are easier to submit and return decisions quicker than faxing paper forms. WebTo continue your electronic prior authorization request, log in. Live Healthy With Blue KC | Kansas City Health Insurance blue kc provider update form. Blue KC has implemented a medical policy to require administration of certain medications in the most cost-effective site of care that is clinically appropriate Find a Form Enter your email address if you would like a reply: The information on this form is collected under the authority of Sections 26(c) and 27(1)(c) of the Freedom of Information and Protection of Privacy Act to help us assess and respond to your enquiry. WebNote: Review of your form and potential reimbursement will be slower than online submissions. A service or medication may require a prior authorization based on your patients plan. WebEffective 2/1/2020, Blue KC discontinued accepting pre-determination requests. WebEffective February 1, 2020 BlueKC will no longer be accepting pre-determination request from providers. Codes must be 3 - 8 characters along with decimals. Patients may also access their own medication history, including Special Authority requests, through Health Gateway. Kansas City, MO 64141-2735. Note that not filling in required fields (Marked with an *) will cause your submission to be rejected. bcbs kc formulary exception form. Bcbs Kansas City Prior Authorization Form - Fill Out and Sign If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842. However, providers may continue submitting pre-determination requests for Federal Employee Last updated: January 23, 2023 Use Special Authority eForms to submit requests. If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842. Register Now Username Password How to Use the Provider Portal If the medication you are looking for is a new-to-market drug, or is not listed, please submit a Prior Authorization WebSite of Care Authorization. Torequest a status update, please call the toll-free Medical Practitioner Line at1-866-905-4912. forms Medical/Dental Claim Form | Download PDF. WebPrior Authorization. If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842. Follow these instructions to activate and enable JavaScript in Internet Explorer. Checking this box will send a copy of your form to the email address provided. Blue KC | Employer | Prior Authorization For cyclosporine and leflunomide, please use the General Special Authority Request (PDF, 656KB). It is on the front of your Member ID card. See the sample ID card above. This information is used by our development staff to address issues you may have found while filling in our various electronic forms. Follow these instructions to activate and enable JavaScript in Safari. An independent licensee of the Blue Cross and Blue Shield Associationdocument.write(new Date().getFullYear()) Blue Cross and Blue Shield of Kansas City. Your prefix is on the front of your Member ID card.