Provider Payment and Coding Policies

Blue KC has developed Provider Payment and Coding Policies to provide guidance on payment methodologies as they pertain to submitted claims. These policies are written following industry standard recommendations from sources such as:

  • Current Procedural Terminology
  • Centers for Medicare and Medicaid
  • American Medical Association
  • National Correct Coding Initiative
  • Other professional organziations and societies

Coverage of any service is determined by date of service, a members's eligibility and benefit limits for the service or services rendered, all terms of the Provider Service Agreement, and other standards of coding rules and guidelines. Final payment is subject to the application of claims adjudication and edits common to the industry. For confirmation of which services may be eligible for coverage and description of when medical services are considered medically necessary, not medically necessary or investigational. In the event of a conflict between any policies, the Member's coverage document will govern.

Anesthesia Processing
Electronic Funds Transfer
Evaluation of Management Services
Facility Routine Supplies and Services
General Coding and Billing
Global Surgical Package
Maternity Services
Urgent Care

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