Member IDs that begin with prefix RKC, RKQ, RRK, RRN, RKN, or RUK are for our Medicare Advantage network. YBD, YBG, YBS, YBM, YBT, YBX, YJV, YJW, YJJ, or YJT are for our Affordable Care Act network.

To access Prior Authorization forms for MA/ACA members use Prior Authorizations Forms.

For Federal Employee Program (FEP) members, please refer to the appropriate service brochures for services that require Prior Approval (https://www.fepblue.org/plan-brochures) OR call the customer service phone number on the back of the member’s ID card. Effective 2/1/2020, Blue KC discontinued accepting pre-determination requests. However, providers may continue submitting pre-determination requests for Federal Employee Program (FEP) and Joint Administrative Account (JAA) lines of business. You can access the e-forms for these pre-determination requests here.

Prior Authorization General Request for Elective Surgery, Procedure, Service or DME

The following services require Prior Authorization (or notification):

• All scheduled elective surgical admissions
• All medical admissions
  • Acute Inpatient (hospital) admissions
  • Acute Rehab facilities
  • Inpatient Hospice
  • Long-term care facilities (LTAC & SNF)
• All Clinical Trials
• All items and services from out-of-network providers require prior authorization.
• All Organ and Tissue Transplants (excluding corneal transplants)
• Chiropractic services performed by an out-of-network provider
• Exceeding OT/PT/ST Benefit Limits for Developmental and Physical Disorders
• The following codes J3490, J3590, J9999 and C9399 are unlisted and do not require PA for all drugs associated with them; however, the following drugs, as well as all new drugs, that are listed under one of these codes DO require PA for all lines of business:
  
  J3490 — Prevymis (letermovir)
  J3590/C9399 — Zynteglo (betibeglogene autotemcel)
  J3490/C9399 — Nulibry (fosdenopterin)
  J3590/C9399 — Skysona (Elivaldogene autotemcel)
  C9399 — Empaveli (pegcetacoplan)
  C9399 — Enspryng (satralizumab-mwge)
  C9399 — Tegsedi (inotersen)
  C9399 — Vivimusta (bendamustine hcl)
  C9399/J3590 — Briumvi (ublituximab)
  C9399/J3590 — Leqembi (lecanemab-itmb)
  C9399/J9999 — Lunsumio (mosunetuzumab-axgb)
  C9399/J3590 — Lamzede (velmanase alfa-tycv)
  C9399/J3590 — Altuviiio (antihemophilic factor (recombinant), Fc-VWF-XTEN fusion protein-ehtl)
  C9399/J9999 — Zynyz (retifanlimab-dlwr)
  C9399/J3490 — Syfovre (pegcetacoplan (intravitreal))
  
  If you have any questions or need help submitting a prior authorization, please call 816-395-3989 for assistance.

Additionally, the following services require Prior Authorization regardless of place of service or level of care:

To submit a prior authorization request you may also fax or mail your request. For the timeliest response, fax the request to 816-926-4253 using this form.

Requests may also be mailed to:

Blue Cross and Blue Shield of Kansas City
Attention: Prior Authorization, Mail Stop B5A1
P.O. Box 411878
Kansas City, MO 64141-1878

Please include any supporting medical information in your fax. Please allow at least 36 hours (to include one business day) from the date of receipt of all necessary information for a determination. To check the status of a prior authorization, call the Customer Service number listed on the member ID card.