Increasing access to prescription medications. 08/2021 Added indication and auth criteria for prevention of episodic migraine . Biologic medications for the treatment of psoriasis are subject to prior authorization. • 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); Check Status. e-News . BCBSKC operates independently of other BCBS Plans. 800-221-2362. Blue KC policies and MCG guidelines can both be searched under their For BCBSKC Use Only . . To submit a prior authorization request you may also fax or mail your request. LINK. Required on some medications before your drug will be covered. Fact: Yes. Inc. d/b/a Blue Care. Blue Cross and Blue Shield Global Core International Claims. at 391-400, 1255-78. These forms include notification forms, admission and inpatient forms, outpatient forms and more. . Some information on our site is secure; log in to ensure you're seeing all the news. See your certificate for a listing of services requiring Prior Authorization). Blue KC's vendor LogicGate has had a cyber security incident that impacted some Blue KC members. Name Brand Medications with an available generic Brand name drugs with an available generic requires the use of that generic. Having difficulties with ePA? P.O. Good Health improperly denied three claim lines under a single claim for ABA The complete medical policy can be found at www.BlueKC.com. Call Clinical Pharmacy Operations at 1-800-366-7778. Kansas City, MO 64108. www.bcbskc.com. • 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. prior authorization as required, Benefits will be reduced to 50% of Eligible Expenses . All 35 Blue Cross and Blue Shield companies are fighting against COVID-19, investing more than $12.8 billion in the nation's recovery. Days 6-90: $0 Copay per day. **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 . References . . Claims dispute and appeals process. It's easy to try. Duplicate submissions slow the process. 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. All home health and hospice services 800-782-4437. 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. All new-to-market medications will require a Prior Authorization. Complete Existing Request. An entity that provides health insurance coverage in the Kansas City, Missouri metropolitan area including Johnson and Wyandotte counties in Kansas. To see what plans we offer and apply online for health insurance, explore our website. Box 238, Topeka, KS 66601-1238 Fax: 785-290-0711 Email: csc@bcbsks.com Section 1 - Provider Information Section 2 - Additional Information Access Forms . Prior Authorization is required and the responsibility of your provider. Discover your estimated out-of-pocket costs for common procedures - all based on your specific health plan. this authorization and release the bank selected by my Employer and Blue KC from all liability arising from such reliance. Inc. (NAIC #95315) (hereinafter . 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. General Inquiries. Claims Inquiry Form ( PDF) Itemized Bill Submission Form. eForm (Commercial members) Submit the appropriate eForm. Read latest news . Pharmacy Claims. Some information on our site is secure; log in to ensure you're seeing all the news. This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City ("BCBSKC"). BCBSKC has retained BlueCross BlueShield of South Carolina as a primary provider of claims processing, customer service, medical management, and other services. *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 . Start date of service. Jemperli Prescribing Information. 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 . Certificate a Certificate of Creditable Coverage from a prior plan or insurer, please contact Blue Cross and Blue Shield of Kansas . The complete medical policy can be found at www.BlueKC.com. Behavioral Health and Substance Use of Nonacute Services (Outpatient Treatment) Request Form. Instead of specific criteria a lot is left up to the surgeon. If prior authorization is required, you can request it by: Phone. MA Blue KC Prior Authorization Form - Medications (Part B) ACA Blue KC Prior Authorization Form - Medical Services, Procedures, and Equipment. I MA/ACA PDF Forms: MA Blue KC Prior Authorization Form - Medical Services, Procedures, and Equipment. 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. BCBSKC 8-digit Provider # or NPI#: _____ Address: _____ Phone: _____ Fax: _____ Please allow 36 hours, to include one (1 . If you want another individual (such as a family member or . For the timeliest response, fax the request to 816-926-4253 using this 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. Blue KC policies and MCG guidelines can both be searched under their You are responsible for prior authorization for services received from non-network and out-of-area providers. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing . genetic testing, high tech radiology). Biologic medications for the treatment of psoriasis are subject to prior authorization. Login. Most prior authorization subjects can also be found within MCG guidelines; however, some subject matter resides in BlueKC policy (e.g. No referrals necessary! 2Total of deductible, coinsurance and copays members pay each year toward covered charges before BCBSKC pays 100% of benefits. BCBSKC 8-digit Provider # or NPI#: _____ Address: _____ Phone: _____ Fax: _____ Please allow 36 hours, to include one (1 . You may also call the Customer Service department at 816-395-2583 or 800-645-8346. 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. 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 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. All in-patient mental health stays 800-952-5906. Box 411878 Kansas City, MO 64141-1878 BCBSKC Reference Number: # of Days or Units Approved: Medical Management Team Member Name: _____ Please allow two (2) business days from date of receipt of . BCBSKC Letterhead Created Date: 8/31/2021 11:00:35 AM . Prior authorization, step therapy and quantity limits may apply to select drugs. Prior authorization is the responsibility of the network provider. 1133 SW Topeka Boulevard. Most medications requiring prior authorization: Mental Health Facility: 45% . BCBSKC Letterhead Created Date: 20210504215639Z . Log in to Fast Forms Create Account & Log In. Previously, the code descriptor stated, "Typically, 5 minutes are spent performing or supervising these services.". 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 . Kansas City, MO 64141. Prior Authorization. If you cannot submit requests to the OptumRx® PA department through ePA or telephone, click here. Overpayment Refund Notification Form. genetic testing, high tech radiology). 4. End date of service. Service code if available (HCPCS/CPT) New Prior Authorization. All in-patient medical stays (requires secure login with Availity) 800-782-4437. Prior Authorization is required and the responsibility of your provider. Princeton, NJ: Bristol-Myers Squibb Company. Other symptoms include fatigue, mucus production, and muscle aches. Prefer to submit your health insurance claim by mail? Billing Coding/Physician Documentation Information 1. Taxpayer ID Form W9. Forms . Requests may also be mailed to: Blue Cross and Blue Shield of Kansas City Attention: Prior Authorization, Mail Stop B5A1 P.O. Blue Cross Blue Shield of Kansas City (NAIC #47171) (hereinafter "Blue Cross KC"), and Good Health HMO. Leading through a public health crisis. GlaxoSmithKline. Blue Cross and Blue Shield of Kansas Attention: Prior Authorization P.O. 816-395-2222. Credentialing Status. These Medical Policies describe when medical services are considered medically necessary, not medically . Organizational Ownership (Job Aid) PDF. Prescriber. Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. Easily fill out PDF blank . BCBSKC has an interesting policy for weight loss surgery. 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. Latest News . search within the MCG guidelines. Incomplete prior authorization requests and forms may result in a denial. 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. Access Institutional Provider resources. You are responsible for prior authorization for services received from non-network and out-of-area providers . search within the MCG guidelines. Provider Acquisition Form. Waiving all prior authorization requirements for COVID-19 testing and related covered services. services for lack of prior authorization implicating the provisions of §375.1007 (3), (4) & (11). Who May Make a Request: Your prescriber may ask us for a coverage determination on your behalf. Opdivo [package insert]. Out-of-Network: Medical Facility: 45% Coinsurance per stay. 1. Medical Policies. Please fax completed forms to (816) 502-4915 If you have any questions please call (816) 395-2176 All patient information is strictly confidential. Complete Prior Authorization/Predetermination Request Please Fax Completed Forms To (816)5024910 If You Have online with US Legal Forms. The symptoms of coronavirus include mild to severe respiratory symptoms. Incomplete forms will be returned. . Little Stars Physician Referral forms. References . We offer easy access to medical forms for BlueCross Blue Shield of SC. 2Total of deductible and coinsurance members pay each year toward covered charges before BCBSKC pays 100% of benefits. 785-291-7000. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. Payment by credit or debit card can . "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. Just sign in to MyBlue and use our Find a Doctor tool to choose any participating provider in our network. **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 . 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. May 2006 - Sep 20126 years 5 months. 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 . Box 419169. Prior Authorization Penalty (Prior Authorization is required for selected services. Blue Cross and Blue Shield of Kansas City (BCBSKC) Definition. . . 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 . Please fax completed forms to (816) 502-4915 If you have any questions please call (816) 395-2176 All patient information is strictly confidential. 2301 Main Street. Transplants with the exception of cornea and kidney 800-432-0272. If you do not have approval before . Specialty drugs For Medical Services: Description of service. Whenever possible, get prior authorization before receiving treatment or check that your doctor has gotten approval. Incomplete forms will be returned. Medical/Dental Claim Form ( PDF) Pharmacy Claim Form ( PDF) BlueCard Worldwide International Claim Form. Prior authorization is required to ensure the safe, clinically appropriate and co, st-effective use of Opdivo while maintaining optimal therapeutic outcomes. Institutional Provider. Authorization Request for Psychological Testing. Top. To contact the Blue KC Prior Authorization Department, call 816-395-3989 or 800-892-6116. Provider Out of Network Form. Search and compare providers or healthcare locations how you prefer. You are responsible for prior authorization for services received. Affected Blue KC members have been notified by mail and can obtain additional information online or by calling 833-664-2014. It is relatively vague compared to most other BCBS weight loss surgery policies. One change to 99211 in 2021 has to do with time. A list of eNews notifications. 1Portion of covered charges paid by BCBSKC after you satisfy your deductible and required copayments. August 2021. Question: Can you search the policies and guidelines? 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. Prior Authorization Your benefit plan may require prior authorization for certain drugs that are high-cost or have the potential for misuse. Portion of covered charges paid by BCBSKC after you satisfy your deductible and required copayments. Disclaimer: Some employer groups have some specific items that require . Other ways to submit a prior authorization. Symptoms include fever, cough, and shortness of breath, and lower respiratory illness. Claim Correspondence Form. 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. Electronic prior authorization for prescribers and pharmacists. Submission Example. Blue Cross and Blue Shield of Kansas City. Covered conditions include Narcolepsy (must fail generic stimulant first) OSAHS, shift work disorder, etc. Total of deductible , coinsurance and copays members pay each year toward covered charges before BCBSKC pays 100% of benefits. *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, . 2Total of deductible and coinsurance members pay each year toward covered charges before BCBSKC pays 100% of benefits. The penalty for not having prior authorization is denial of payment. BCBSKC will provide coverage for Provigil® (modafinil) or Nuvigil® (armodafinil) when it is determined to be medically necessary. . BCBSKC-EEAPP (100+) NO LIFE-2/10 1 12/12 Preferred-Care PPO Preferred-Care Blue PPO . BCBS Kansas (BCBSKC) will provide coverage for weight loss surgery when it is deemed to be medically necessary because the criteria below are met. BCBSKC - EE App - Large - 5/10 1 III 12/12. Sr. Director, Specialty Reporting and Analytics Services; September 2010- September 2012. Corrected Claim Form. Most prior authorization subjects can also be found within MCG guidelines; however, some subject matter resides in BlueKC policy (e.g. Fact: Yes. Pre-certification required. Criteria for coverage includes failure of topical therapy, photo therapy, systemic oral therapy, >10%BSA, and functional impairment. Medco Health Solutions. (For Federal Employee Program members, call CVS/Caremark at 1-877-727-3784 .) Check the initial credentialing status for new providers. A nurse can document the amount of . J9299 Injection, nivolumab, 1 mg You've got a new pain-relief option: We now cover 12 acupuncture sessions each year as part of your plan.*. 2. Criteria for coverage includes failure of topical therapy, photo therapy, systemic oral therapy, >10%BSA, and functional impairment.
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