The purpose of this inquiry is to provide the initial credentialing status for new providers. This is not for validation of re-credentialing or contracting.

A provider has the right to review information obtained by Blue KC to evaluate his/her credentialing application. This review may include information from any outside source (for example, malpractice insurance carriers or state-licensing boards). Blue KC will make a decision whether to approve or deny a credentialing application within 60 business days of receipt of the completed application. The provider has the right to correct erroneous information and, upon request, to be informed of the status of his/her credentialing or recredentialing application.

Do not use this form to check on the status of your Blue KC contract or to request your provider number. Please contact your Provider Relations Representative.

Please provide the following information so that we can accurately respond to your request:

- Practice Name
Provider Name:
- First Name
- Middle Initial
- Last Name
- Provider Specialty
- Date of Birth
Practice Address:
- Street Address
- City
- State
- Zip
- Phone Number
Contact Name:
- First Name
- Last Name
- Contact Phone Number
- Contact Email
- Questions or Comments
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The purpose of this inquiry is to provide the initial credentialing status for new providers. This is not for validation of re-credentialing or contracting.

Provider Name:

Practice Address:

Contact Name: