Kansas City, MO 64108. www.bcbskc.com. Duplicate submissions slow the process. Blue Cross and Blue Shield of Kansas Attention: Prior Authorization P.O. Princeton, NJ: Bristol-Myers Squibb Company. BCBS Kansas (BCBSKC) will provide coverage for weight loss surgery when it is deemed to be medically necessary because the criteria below are met. Prior authorization is required to ensure the safe, clinically appropriate and co, st-effective use of Opdivo while maintaining optimal therapeutic outcomes. 2Total of deductible and coinsurance members pay each year toward covered charges before BCBSKC pays 100% of benefits. Forms . BCBSKC will provide coverage for Provigil (modafinil) or Nuvigil (armodafinil) when it is determined to be medically necessary. It is relatively vague compared to most other BCBS weight loss surgery policies. Call 1-800-711-4555, 5 a.m. - 10 p.m. PT, Monday-Friday and 6 a.m. - 3 p.m. PT, Saturday. Billing Coding/Physician Documentation Information These forms include notification forms, admission and inpatient forms, outpatient forms and more. **Prior Authorization will be required for elective inpatient admissions, durable medical equipment (DME), infusion therapy and self injectables, organ and tissue transplants, some outpatient surgeries and services, hi-tech . For dates of service on or after Jan. 1, 2021, you cannot bill 99211 based on time alone, as you can for the rest of the office visit codes. Complete Prior Authorization/Predetermination Request Please Fax Completed Forms To (816)5024910 If You Have online with US Legal Forms. Who May Make a Request: Your prescriber may ask us for a coverage determination on your behalf. Read latest news . 1133 SW Topeka Boulevard. We offer easy access to medical forms for BlueCross Blue Shield of SC. Biologic medications for the treatment of psoriasis are subject to prior authorization. Organizational Ownership (Job Aid) PDF. Acupuncture is covered. Prior Authorization is required and the responsibility of your provider. If you do not have approval before . GlaxoSmithKline. all necessary information for determination. Group and Practitioner Enrollment (Job Aid) PDF. For the timeliest response, fax the request to 816-926-4253 using this form. CO 23 Denial Code - The impact of prior payer(s) adjudication including payments and/or adjustments; CO 26 CO 27 and CO 28 Denial Codes; CO 31 Denial Code- Patient cannot be identified as our insured; CO 45 Denial Code; CO 97 Denial Code; CO 119 Denial Code - Benefit maximum for this time period or occurrence has been reached or exhausted Covered conditions include Narcolepsy (must fail generic stimulant first) OSAHS, shift work disorder, etc. 1. . you must provide copies of the Certificates of Creditable Coverage or other acceptable proof of coverage from the prior plan(s) or the following information for the . City (NAIC #47171) (hereinafter "BCBSKC"), examination report number 1603-22-TOTand the market conduct examination report of Good Health HMO, Inc. d/b/a Blue Care, Inc. (NAIC . BCBSKC Letterhead Created Date: 20210504215639Z . Education and assistance to help you understand the prior authorization (PA) process--if your serivce requires PA review Find a healthcare provider locally or out of area based on your care needs. Days 6-90: $0 Copay per day. services for lack of prior authorization implicating the provisions of 375.1007 (3), (4) & (11). MA/ACA PDF Forms: MA Blue KC Prior Authorization Form - Medical Services, Procedures, and Equipment. . Prior authorization is the responsibility of the network provider. Log in to Fast Forms Create Account & Log In. search within the MCG guidelines. Portion of covered charges paid by BCBSKC after you satisfy your deductible and required copayments. this enrollment application or failure to provide additional information about changes prior to the date on which the Contract is issued, may result in a re-rate of the premium . v.01/20 . Little Stars Physician Referral forms. Fact: Yes. Plaintiff also received BCBSKC's EOBs informing her that billed charges from Elements and Boulder Creek were denied because Plaintiff did not first obtain prior authorization and/or a referral was not obtained. . May 2006 - Sep 20126 years 5 months. Behavioral Health. Access Forms . Incomplete prior authorization requests and forms may result in a denial. BCBSKC will provide coverage for Provigil (modafinil) or Nuvigil (armodafinil) when it is determined to be medically necessary. Search and compare providers or healthcare locations how you prefer. 4. To contact the Blue KC Prior Authorization Department, call 816-395-3989 or 800-892-6116. Institutional Provider. Start date of service. Whenever possible, get prior authorization before receiving treatment or check that your doctor has gotten approval. Disclaimer: Some employer groups have some specific items that require . Affected Blue KC members have been notified by mail and can obtain additional information online or by calling 833-664-2014. The penalty for not having prior authorization is denial of payment. this authorization and release the bank selected by my Employer and Blue KC from all liability arising from such reliance. Providers must use correct codes to indicate whether audio and video equipment or audio only was used when performing evaluation and management (E/M) services via telehealth for Blue Advantage patients. Inc. (NAIC #95315) (hereinafter . *Prior Authorization will be required for elective inpatient admissions, durable medical equipment (DME), infusion therapy and self-injectables, organ and tissue transplants, some outpatient surgeries and services, hi-tech . Any coupon, rebate or other credits received directly or indirectly from the drug manufacturer may not be applied to a consumer's deductible, cost-sharing or out of pocket maximum. One change to 99211 in 2021 has to do with time. 2Total of deductible and coinsurance members pay each year toward covered charges before BCBSKC pays 100% of benefits. If the medication you are looking for is a new-to-market drug, or is not listed, please submit a Prior Authorization here. On May 17, 2016, Plaintiff requested retrospective reviews of BCBSKC's denial If the request is not approved, please remember that you . eForm (Commercial members) Submit the appropriate eForm. . Mental Health Facility: 45% . prior authorization as required, Benefits will be reduced to 50% of Eligible Expenses . 2Total of deductible, coinsurance and copays members pay each year toward covered charges before BCBSKC pays 100% of benefits. company that provides Pharmacy Benefits on behalf of BCBSKC: 1-877-512-5981 For inquiries regarding the status of prior authorization on Specialty Drugs dispensed by Accredo, please call: 1-877-512-5981 For information regarding Quantity versus Time (QVT) Limits or Step Therapy Programs, contact your Customer Service Representative. 2Total of deductible and coinsurance members pay each year toward covered charges before BCBSKC pays 100% of benefits. To check the status of a prior authorization, call the Customer Service number listed on the member ID card. Biologic medications for the treatment of psoriasis are subject to prior authorization. search within the MCG guidelines. Blue Cross and Blue Shield Global Core International Claims. You can submit a verbal PA request. Blue Cross and Blue Shield of Kansas City. Sr. Director, Knowledge . A nurse can document the amount of . You've got a new pain-relief option: We now cover 12 acupuncture sessions each year as part of your plan.*. Some information on our site is secure; log in to ensure you're seeing all the news. Most prior authorization subjects can also be found within MCG guidelines; however, some subject matter resides in BlueKC policy (e.g. Previously, the code descriptor stated, "Typically, 5 minutes are spent performing or supervising these services.". Quality Care That's Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find.BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Prior Authorization will be required for elective inpatient admissions, durable medical equipment (DME), infusion therapy and self injectables, organ and tissue transplants, some outpatient surgeries and services . Other ways to submit a prior authorization. Behavioral Health and Substance Use of Nonacute Services (Outpatient Treatment) Request Form. Prior Authorization Penalty (Prior Authorization is required for selected services. Pre-certification required. MA Blue KC Prior Authorization Form - Medications (Part B) ACA Blue KC Prior Authorization Form - Medical Services, Procedures, and Equipment. All new-to-market medications will require a Prior Authorization. genetic testing, high tech radiology). Access Institutional Provider resources. 785-291-7000. Check Status. All in-patient mental health stays 800-952-5906. Jemperli Prescribing Information. Credentialing Status. prior authorization process for ABA services by a utilization review organization acting on the BCBSKC Letterhead Created Date: 8/31/2021 11:00:35 AM . Sr. Director, Specialty Reporting and Analytics Services; September 2010- September 2012. Pharmacy Claims. . . 1. Prior Authorization Your benefit plan may require prior authorization for certain drugs that are high-cost or have the potential for misuse. For BCBSKC Use Only . Please fax completed forms to (816) 502-4915 If you have any questions please call (816) 395-2176 All patient information is strictly confidential. (For Federal Employee Program members, call CVS/Caremark at 1-877-727-3784 .) We are expanding access to vaccines, educating communities, and meeting ongoing healthcare and social needs in communities across the country. Fact: Yes. EFT, OPL, CAQH, Predetermination Requests and many other helpful forms. BCBSKC has retained BlueCross BlueShield of South Carolina as a primary provider of claims processing, customer service, medical management, and other services. If you are using one of these devices please use the PDF to complete your form. Please fax completed forms to (816) 502-4915 If you have any questions please call (816) 395-2176 Gilenya may be considered for coverage in members with relapsing forms of multiple sclerosis genetic testing, high tech radiology). Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Incomplete forms will be returned. BCBSKC - EE App - Large - 5/10 1 III 12/12. Prescriber. . Blue KC policies and MCG guidelines can both be searched under their Having difficulties with ePA? Covered conditions include Narcolepsy (must fail generic stimulant first) OSAHS, shift work disorder, etc. Corrected Claim Form. Opdivo [package insert]. Complete Existing Request. Question: Can you search the policies and guidelines? Instead of specific criteria a lot is left up to the surgeon. If prior authorization is required, you can request it by: Phone. See your certificate for a listing of services requiring Prior Authorization). Name Brand Medications with an available generic Brand name drugs with an available generic requires the use of that generic. Required on some medications before your drug will be covered. Criteria for coverage includes failure of topical therapy, photo therapy, systemic oral therapy, >10%BSA, and functional impairment. End date of service. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. Certificate a Certificate of Creditable Coverage from a prior plan or insurer, please contact Blue Cross and Blue Shield of Kansas . Box 419169. Good Health improperly denied three claim lines under a single claim for ABA Payment by credit or debit card can . If you have questions as you look at our plan options, contact a Blue KC marketing representative at 800-860-2227. Billing Coding/Physician Documentation Information . 816-395-2222. Franklin Lakes, NJ. The following forms can be found inside your MyBlueKC portal: Medical/Dental Claims. BCBSKC 8-digit Provider # or NPI#: _____ Address: _____ Phone: _____ Fax: _____ Please allow 36 hours, to include one (1 . Just sign in to MyBlue and use our Find a Doctor tool to choose any participating provider in our network. Criteria for coverage includes failure of topical therapy, photo therapy, systemic oral therapy, >10%BSA, and functional impairment. You may also call the Customer Service department at 816-395-2583 or 800-645-8346. Requests may also be mailed to: Blue Cross and Blue Shield of Kansas City Attention: Prior Authorization, Mail Stop B5A1 P.O. You are responsible for prior authorization for services received from non-network and out-of-area providers. Provider Out of Network Form. If you want another individual (such as a family member or . To see what plans we offer and apply online for health insurance, explore our website. CREDIT OR DEBIT CARD AUTHORIZATION: We offer the convenience of paying by credit or debit card. BCBSKC-EEAPP (100+) NO LIFE-2/10 1 12/12 Preferred-Care PPO Preferred-Care Blue PPO . For Medical Services: Description of service. Claims Inquiry Form ( PDF) Itemized Bill Submission Form. Increasing access to prescription medications. Medco Health Solutions. A list of eNews notifications. . Check the initial credentialing status for new providers. 2Total of deductible, coinsurance and copays members pay each year toward covered charges before BCBSKC pays 100% of benefits. The symptoms of coronavirus include mild to severe respiratory symptoms. August 2021. Prior authorization, sometimes called pre-certification, is how Blue Cross makes sure the treatment your doctor prescribes is medically necessary and helps ensure you are receiving proper care. 2301 Main Street. *Prior Authorization will be required for elective inpatient admissions, durable medical equipment (DME), infusion therapy and self injectables, organ and tissue transplants, some outpatient surgeries and services, . . Access CoverMyMeds . BCBSKC 8-digit Provider # or NPI#: _____ Address: _____ Phone: _____ Fax: _____ Please allow 36 hours, to include one (1 . This form should be used when prior authorization of the services is required by Blue Cross and Blue Shield of Kansas. Question: Can you search the policies and guidelines? U.S. District Judge Ortrie D. Smith has granted summary judgment to Blue Cross Blue Shield Kansas City in a dispute over reimbursement for mental health treatment. Taxpayer ID Form W9 (Job Aid) PDF. Authorization Request for Psychological Testing. BCBSKC operates independently of other BCBS Plans. Topeka, KS 66629-0001. www.bcbsks.com. Other symptoms include fatigue, mucus production, and muscle aches. Box 411878 Kansas City, MO 64141-1878 BCBSKC-DIRECT-7/13 1 10/13 II . . Prescription Drugs (5) BCBSKC Rx Network: $12 copay for Tier 1 drug; Tier 1 generic contraceptives covered at 100% $30 copay for Tier 2 brand drug; . Out-of-Network: Medical Facility: 45% Coinsurance per stay. Specialty drugs References . Leading through a public health crisis. Most medications requiring prior authorization: Prior authorization is required to ensure the safe, clinically appropriate and cost - effective use of Jemperli (dostarlimab-gxly) while maintaining optimal therapeutic outcomes. Nurtec (rimegepant) requires prior authorization through the Clinical Pharmacy Department. . Prior Authorization is required and the responsibility of your provider. I agree that this authorization shall be valid for two (2) years from the application date. The companion E&M codes for 99354 are: Office or Other Outpatient visit codes (99201 - 99205, 99212 - 99215); Office or Other Outpatient Consultation codes (99241 - 99245); I In-network providers will be paid at their contracted rate. e-News . Waiving all prior authorization requirements for COVID-19 testing and related covered services. If your health plan's formulary guide indicates that you need a Prior Authorization for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. Transplants with the exception of cornea and kidney 800-432-0272. Blue Cross Blue Shield of Kansas City (NAIC #47171) (hereinafter "Blue Cross KC"), and Good Health HMO. Research Triangle Park, NC. P.O. Medical/Dental Claim Form ( PDF) Pharmacy Claim Form ( PDF) BlueCard Worldwide International Claim Form. Blue Cross and Blue Shield of Kansas City (BCBSKC) Definition. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing . . Easily fill out PDF blank . Prior authorization, step therapy and quantity limits may apply to select drugs. "It is important that our members feel safe and secure during these unprecedented times," said Scott P. Serota, current president and CEO of the Blue Cross Blue Shield Association. Electronic prior authorization for prescribers and pharmacists. Please fax completed forms to (816) 502-4915 If you have any questions please call (816) 395-2176 All patient information is strictly confidential. Prior Authorization will be required for elective inpatient admissions, durable medical equipment (DME), infusion therapy and self injectables, organ and tissue transplants, some outpatient surgeries . Some information on our site is secure; log in to ensure you're seeing all the news. **Prior Authorization will be required for elective inpatient admissions, durable medical equipment (DME), infusion therapy and self injectables, organ and tissue transplants, some outpatient surgeries and services, hearing . Box 238, Topeka, KS 66601-1238 Fax: 785-290-0711 Email: [email protected] Section 1 - Provider Information Section 2 - Additional Information All home health and hospice services 800-782-4437. If you cannot submit requests to the OptumRx PA department through ePA or telephone, click here. Id. Overpayment Refund Notification Form. at 391-400, 1255-78. Blue KC policies and MCG guidelines can both be searched under their Blue Cross and Blue Shield of Kansas. Symptoms include fever, cough, and shortness of breath, and lower respiratory illness. Provider Acquisition Form. UB04 Billing. Discover your estimated out-of-pocket costs for common procedures - all based on your specific health plan. Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. 800-221-2362. Total of deductible , coinsurance and copays members pay each year toward covered charges before BCBSKC pays 100% of benefits. All member information is strictly confidential. BCBSKC Reference Number: # of Days or Units Approved: Medical Management Team Member Name: _____ Please allow two (2) business days from date of receipt of . Obtain forms for: Pre-authorization Pharmacy, Pre-service, Utilization Management, and. References . This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City ("BCBSKC"). Service code if available (HCPCS/CPT) New Prior Authorization. It's easy to try. Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for COVID-19 telehealth services, as described below.For non-COVID-19 telehealth services, benefits will be adjudicated in accordance with the member's health plan, as applicable. All 35 Blue Cross and Blue Shield companies are fighting against COVID-19, investing more than $12.8 billion in the nation's recovery. 1Portion of covered charges paid by BCBSKC after you satisfy your deductible and required copayments. No referrals necessary! Claims dispute and appeals process. These Medical Policies describe when medical services are considered medically necessary, not medically . Claim Correspondence Form. The complete medical policy can be found at www.BlueKC.com. View the latest provider news. Latest News . Prefer to submit your health insurance claim by mail? LINK. 08/2021 Added indication and auth criteria for prevention of episodic migraine . Taxpayer ID Form W9. 4 v.01/20 You are responsible for prior authorization for services received. Incomplete forms will be returned. J9299 Injection, nivolumab, 1 mg To submit a prior authorization request you may also fax or mail your request. Prior Authorization. 2. You are responsible for prior authorization for services received from non-network and out-of-area providers . All in-patient medical stays (requires secure login with Availity) 800-782-4437. View the latest provider news. This means that your doctor will need to submit a prior authorization request for coverage of these medications, and the request will need to be approved, before the medication will be covered under your plan. Top. General Inquiries. If eligible, you'll see SmartShopper, helping you shop and earn cash-back rewards for choosing quality, cost-effective providers for common medical tests and procedures. The complete medical policy can be found at www.BlueKC.com. An entity that provides health insurance coverage in the Kansas City, Missouri metropolitan area including Johnson and Wyandotte counties in Kansas. Blue KC's vendor LogicGate has had a cyber security incident that impacted some Blue KC members. BCBSKC has an interesting policy for weight loss surgery. Recoupment Form. Out-of-network Note: If you see Medicare members or accept Medicare assignment and are willing to bill BCBSTX, you may treat Blue Cross Group Medicare Advantage Open Access (PPO) members. Call Clinical Pharmacy Operations at 1-800-366-7778. Medical Policies. Attn: Prior Authorization 10181 Scripps Gateway Ct. San Diego, CA 92131 You may also ask us for a coverage determination by phone 1-866-508-7140 or through our website at www.BlueKCMA.com. . Login. Inc. d/b/a Blue Care. Most prior authorization subjects can also be found within MCG guidelines; however, some subject matter resides in BlueKC policy (e.g. December 2017. Prior authorization is the responsibility of the network provider. Kansas City, MO 64141. Use traditional E/M CPT codes 99201-99205, 99211-99215 and be sure to include a statement in the medical record that audio and video were used. Mental Health Facility: Days 1-5: $250 Copay per day for each admission. Submission Example.