https providers bluekc com eforms form priorauthpredetermination

Note that not filling in required fields (Marked with an *) will cause your submission to be rejected. An independent licensee of the Blue Cross and Blue Shield Associationdocument.write(new Date().getFullYear()) Blue Cross and Blue Shield of Kansas City. For cyclosporine and leflunomide, please use the General Special Authority Request (PDF, 656KB). However, providers may continue submitting pre-determination requests for Federal Employee Follow these instructions to activate and enable JavaScript in Chrome. Excessive daytime sleepiness *, Epworth Sleepiness Score: Chronic pulmonary disease (i.e., severe or uncontrolled asthma, COPD, sarcoidosis) *. 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. WebIf you experience issues submitting this form, please print and fax it to one of the following: Local HMO/PPO 816-278-1944. blue kc provider update form. See the sample ID card above. Choose a file or files to attach (File types accepted: jpg, txt, doc, docx, pdf, xls, xlsx, ppt, pptx, rtf, tiff, and tif). A service or medication may require a prior authorization based on your patients plan. Box 412735 Pharmacy Services Box 412735 Follow these instructions to activate and enable JavaScript in Firefox. If you experience issues submitting this form, please try again later. Checking this box will send a copy of your form to the email address provided. Kansas City, MO 64141-2735. If you have questions, contact Blue KC at (816) 395-3989. Thank you. WebClaims Prior Authorization Resources Medical Policies Account Forms Ensure you are using the latest web browser version in order to submit electronic forms. Follow these instructions to activate and enable JavaScript on your Android. You can request an electronic prior authorization by continuing below. See How to submit a Special Authority request . To upload multiple files, hold down the CTRL key while selecting multiple documents then click open. eForms areeasier to submit and return decisions quicker than faxing paper forms. Diagnosis Codes must be 3-8 characters along with decimals. Medical/Dental Claim Form | Download PDF. To ensure the proper functionality of electronic forms you must have JavaScript enabled and be using a current version of your browser. Codes must be 3 - 8 characters and 2 decimals. Special Authority requests must be completed by a licensed medical prescriber. Is this a CPAP titration/re-titration? All rights reserved. Follow these instructions to activate and enable JavaScript in iOS on the iPhone and iPad. Jump toCGM, insulin pumps and blood glucose test strips|Compounded medications, General Special Authority request (use only if there is no specific form below). WebSite of Care Authorization. Thank you. WebPrior Authorization Blue Cross and Blue Shield of Kansas City (Blue KC) may require prior authorization before certain medical services and/or medications are performed or Special Authority requests must be completed by a licensed medical prescriber. Your prefix is on the front of your Member ID card. P.O. It is on the front of your Member ID card. UseSpecial Authority eFormsto submit requests. Your member ID is a unique number that identifies your plan. Obtain forms for: Pre-authorization Pharmacy, Pre-service, Utilization Management, and; Little Stars WebIf you are using one of these devices please use the PDF to complete your form. Codes must be 3 - 8 characters along with decimals. Follow these instructions to activate and enable JavaScript in Safari. abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, Attention deficit hyperactivity disorder (ADHD), mixed-amphetamine salts ER, lisdexamfetamine, methylphenidate ER (Concerta-type generics), atomoxetine, deferasirox, iron isomaltoside, iron sucrose, dabigatran, rivaroxaban, ticagrelor, ivabradine,sacubitril-valsartan, ARBs(candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan), empagliflozin, empagliflozin-metformin, insulin detemir, insulin glargine, insulin pump,linagliptin, pioglitazone, saxagliptin, semaglutide, proton pump inhibitors, adalimumab, infliximab, rifaximin, vedolizumab, obeticholic acid, Hepatitis B: adefovir, entecavir, interferon alpha, lamivudine, tenofovir For Blue Card members, suffix is not required. Register Now Username Password How to Use the Provider Portal WebTo continue your electronic prior authorization request, log in. Follow these instructions to activate and enable JavaScript on your Android. 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 WebInsert Attachments. Copy the following then paste it into the Firefox address bar: To the right of the address bar, click the icon with. Open a new Firefox browser window or tab. If you can't find theform you need below, search for the drug in the, Employment, business and economic development, Employment standards and workplace safety, Birth, adoption, death, marriage and divorce, Environmental protection and sustainability, Tax verification, audits, rulings and appeals, Transportation and infrastructure projects, Fraser Valley Highway 1 Corridor Improvement Program, Highway 1 - Lower Lynn Improvements Project, Belleville Terminal Redevelopment Project, How to submit a Special Authorityrequest, CGM, insulin pumps and blood glucose test strips, General Special Authority Request (PDF, 656KB), Donepezil, Galantamine and Rivastigmine (PDF, 350KB), Standardized Mini-Mental State Examination (SMMSE) (PDF, 690KB), Global Deterioration Scale (GDS) (PDF, 198KB), Letermovir Special Authority Request Form (PDF, 358KB), Rivaroxaban for Concomitant Coronary Artery Disease and Peripheral Artery Disease (PDF, 362KB), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) (PDF, 64KB), Adalimumab/Etanercept/Golimumab/Infliximab/secukinumab for Ankylosing Spondylitis: Initial/Switch (PDF, 242KB), Adalimumab/Etanercept/Golimumab/Infliximab/secukinumab for Ankylosing Spondylitis: Renewal (PDF, 237KB), Adalimumab/Etanercept/Golimumab/Infliximab/secukinumab for Psoriatic Arthritis: Initial/Switch (PDF, 241KB), Adalimumab/Etanercept/Golimumab/Infliximab/secukinumab for Psoriatic Arthritis: Renewal (PDF, 224KB), Patient Health Assessment Questionnaire (HAQ) (PDF, 528KB), Abatacept/Adalimumab/Certolizumab/Etanercept/Golimumab/Infliximab/Tocilizumab for Rheumatoid Arthritis: Initial/Switch (PDF, 604KB), Abatacept/Adalimumab/Certolizumab/Etanercept/Golimumab/Infliximab/Tocilizumab for Rheumatoid Arthritis: Renewal (PDF, 406KB), Rituximab for Rheumatoid Arthritis: Initial/Renewal (PDF, 388KB), Medication Coverage for Attention Deficit and Hyperactivity Disorder (PDF, 606KB), Deferasirox Coverage: Initial/Switch (PDF, 360KB), Intravenous Iron for Iron Deficiency Anemia (PDF, 90KB), Dabigatran/Rivaroxaban for Atrial Fibrillation (PDF, 478KB), Ticagrelor for Acute Coronary Syndromes (PDF, 460KB), Sacubitril-valsartan for heart failure (PDF, 382KB), Ivabradine forheart failure (PDF, 302KB), ARBs: candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan (PDF, 672KB), Continuous Subcutaneous Insulin Infusion (Insulin Pump) (PDF, 473KB), Insulin Glargine and Insulin Detemir (PDF, 500KB), Third-Line Anti-Diabetic Medications (PDF, 633KB), Biologics for Moderate to Severe Active Crohns/Fistulizing Crohns: Initial/Switch (PDF, 751KB), Biologics for Moderate to Severe Active Crohns/Fistulizing Crohns: Renewal (PDF, 607KB), Worksheet (based on Harvey-Bradshaw Index) (PDF, 514KB), Biologics for Ulcerative Colitis: Initial/Switch (PDF, 940KB), Biologics for Ulcerative Colitis: Renewal (PDF, 608KB), Obeticholic acid for primary biliary cholangitis (PDF, 315KB), Chronic Hepatitis B: Initial/Renewal (PDF, 189KB), Sofosbuvir in Combination with Ribavirin for Chronic Hepatitis C (PDF, 413KB), Velpatasvir Plus Sofosbuvir With/Without Ribavirin for Chronic Hepatitis C (PDF, 413KB), Ledipasvir Plus Sofosbuvir With/Without Ribavirin for Chronic Hepatitis C (PDF, 419KB), Sofosbuvir-velpatasvir-voxilaprevir for Chronic Hepatitis C (PDF, 414KB), Glecaprevir plus pibrentasvir (PDF, 663KB), Evolocumab for Heterozygous Familial Hypercholesterolemia (PDF, 586KB), Tocilizumab for Giant Cell Arteritis (PDF, 316KB), Disease Modifying Drugs for Multiple Sclerosis:Initial/Renewal/Switch (PDF, 785KB), Natalizumab (Tysabri) for Multiple Sclerosis: Initial/Renewal (PDF, 568KB), Fingolimod for Multiple Sclerosis:Initial/Renewal (PDF, 323KB), Alemtuzumab (Lemtrada) for Multiple Sclerosis (PDF, 519KB), Ocrelizumab for Primary Progressive Multiple Sclerosis (PDF, 594KB), Cladribine (Mavenclad) for Multiple Sclerosis (PDF, 919KB), Edaravone for Amyotrophic Lateral Sclerosis (ALS)(PDF, 93KB), Inhalers for Chronic Obstructive Pulmonary Disease (COPD) (PDF, 403KB), Nintedanib and Pirfenidone for Idiopathic Pulmonary Fibrosis (PDF, 532KB), Benralizumab and Mepolizumab for severe eosinophilic asthma (PDF, 431 KB), Asthma Triple Inhaler (ICS-LABA-LAMA) (PDF, 1.08MB), Psoriasis Area and Severity Index (PASI) Worksheet (PDF, 529KB), Biologics for Moderate to Severe Psoriasis (PDF, 365KB), Adalimumab for the treatment of active moderate to severe hidradenitis suppurativa (PDF, 310KB), Rituximab for Granulomatosis with Polyangiitis or Microscopic Polyangiitis: Initial/Renewal (PDF, 500KB), Dalteparin/Enoxaparin (Biosimilar)/Nadroparin/Tinzaparin Low Molecular Weight Heparin (PDF, 548KB), Dalteparin/Tinzaparin/Enoxaparin (Biosimilar) for Treatment of Venous Thromboembolism in CancerPatients (PDF, 573KB), Dexcom G6 CGM: Initial and Renewal Coverage Request (PDF, 92KB), Continuous Subcutaneous Insulin Infusion (Insulin Pump): Initial/Renewal (PDF, 473KB), Additional Blood Glucose Test Strips (PDF, 301KB). FEP 816-395-3811. Follow these instructions to activate and enable JavaScript in Opera. For Blue Card members, suffix is not required. This information is used by our development staff to address issues you may have found while filling in our various electronic forms. eForms are easier to submit and return decisions quicker than faxing paper forms. Blue KC will provide coverage for Sleep Studies when it is determined to be medically necessary. https providers bluekc com Webproviders may continue submitting pre-determination requests for Federal Employee Program (FEP) and Joint Administrative Account (JAA) lines of business. bcbs of kansas prior authorization forms. Credentialing Status. Credentialing Status. Last updated: January 23, 2023 Use Special Authority eForms to submit requests. Follow these instructions to activate and enable JavaScript in Internet Explorer. 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 Opera. Incompleteforms will not be processed. See the sample ID card above. For Blue Card members, suffix is not required. Select your browser type and follow these instructions to activate and enable JavaScript or contact your administrator if you continue to experience issues. If yes, please attach a copy of the last sleep study. Your member ID is a unique number that identifies your plan. Enrol now. All rights reserved. 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. Submitting this feedback form does not include a submission of your form request. P.O. It is on the front of your Member ID card. 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. IMPORTANT: If you are an FEP Member, enter "NA" into the Prefix field. The online form Checking this box will send a copy of your form to the email address provided. Checking this box will send a copy of your form to the email address provided. WebNote: Review of your form and potential reimbursement will be slower than online submissions. adalimumab, etanercept, golimumab, infliximab, secukinumab. Copy the following then paste it into the Firefox address bar: To the right of the address bar, click the icon with. An independent licensee of the Blue Cross and Blue Shield Associationdocument.write(new Date().getFullYear()) Blue Cross and Blue Shield of Kansas City. bcbs kc formulary exception form. WebWe empower providers in our networks to improve care delivery for you. It is on the front of your Member ID card. IMPORTANT: If you are an FEP Member, enter "NA" into the Prefix field. Incomplete forms will not be processed. See the sample ID card above. WebEffective 2/1/2020, Blue KC discontinued accepting pre-determination requests. See the sample ID card above. Your feedback is greatly appreciated. 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. Open a new Firefox browser window or tab. WebCheck the initial credentialing status for new providers. Your Suffix is a two digit number located on your Member ID card. See the sample ID card above. Your member ID is a unique number that identifies your plan. Kansas City, MO 64141-2735. WebAll new-to-market medications will require a Prior Authorization. *, Choose a file or files to attach (File types accepted: jpg, txt, doc, docx, pdf, xls, xlsx, ppt, pptx, rtf, tiff, and tif). WebEffective February 1, 2020 BlueKC will no longer be accepting pre-determination request from providers. If the medication you are looking for is a new-to-market drug, or is not listed, please submit a Prior Authorization Follow these instructions to activate and enable JavaScript in Chrome. Follow these instructions to activate and enable JavaScript in Internet Explorer. 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 for a members condition. See the sample ID card above. Follow these instructions to activate and enable JavaScript in Opera. WebSleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist. To ensure the proper functionality of electronic forms you must have JavaScript enabled and be using a current version of your browser. Select your browser type and follow these instructions to activate and enable JavaScript or contact your administrator if you continue to experience issues. To ensure the proper functionality of electronic forms you must have JavaScript enabled and be using a current version of your browser. 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. If you can't find theform you need below, search for the drug in theSpecial Authority drugslist. Your prefix is on the front of your Member ID card. Select your browser type and follow these instructions to activate and enable JavaScript or contact your administrator if you continue to experience issues. 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. Claim Inquiry Form | Download Note that not filling in required fields (Marked with an *) will cause your submission to be rejected. See the sample ID card above. WebCheck the initial credentialing status for new providers. Blue Cross and Blue Shield of Kansas City Choose a file or files to attach * (File types accepted: jpg, txt, doc, docx, pdf, xls, xlsx, ppt, pptx, rtf, tiff, and tif). Webbcbs kc inquiry form. 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 Firefox. Providers may continue to submit pre-determinations for Federal Employee Follow these instructions to activate and enable JavaScript in Safari. Torequest a status update, please call the toll-free Medical Practitioner Line at1-866-905-4912. 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 Follow these instructions to activate and enable JavaScript on your Android.

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