Use our tool to see if prior authorization is required. Select a line of business to see the the list of prior authorizations related to the member details selected. The member prefix can be found on the member ID card, before the member ID number.
Select Line of Business or Member Prefix*
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
Note: A Blue KC Provider Account is required for submitting a prior auth. Find account details, BlueKC eForms, and fax information on Additional Resources. If a code cannot be located, you may still request a prior auth. Code lists are subject to change.
View Existing Requests
Existing Prior Authorizations Medical Services, Procedures, Equipment, or Medications (Medical Benefit Rx)
If you created a prior authorization for a medical service or non-pharmacy dispensed drug, select Continue. On the final step of the process, select the View Existing Requests button.
If you created a prior authorization for a pharmacy dispensed drug, select Continue. In the next step you will be prompted to input the member ID, then will be directed to the proper prior authorization tool.
Note: To identify the prior authorization service type, use the prior authorization lookup tool found on the Prior Authorization tab. If you have additional questions you may contact us at (816) 395 - 3700.
Blue KC Provider Portal Account
Electronic Prior Authorizations require a Blue KC Provider Portal account
In-Network Providers Organizational Administrators can request a Blue KC Provider account here. Non-Organization Administrators (Standard users), contact your Organizational Administrator.
Out-of-Network Providers create a Blue KC Provider account here. For existing account help, call the Blue KC provider hotline at 816-395-3700.
Blue KC eForms
For prior authorization, use the below list of Blue KC eForms.
You may also submit requests by fax or mail. Please include any supporting medical information in your request. Check the status of an existing request using the customer service number listed on the member ID card.
Commercial, FEP, and JAA Plan Member Contact Information
Commercial Plan Members Medical Service, Procedure, or Equipment Fax Requests Fax Requests: (816) 926 - 4253
Commercial Plan Member Mail-in Requests: Blue Cross and Blue Shield of Kansas City
Attention: Prior Authorization, Mail Stop B5A1
P.O. Box 411878
Kansas City, MO 64141-1878
MA /ACA Plan Member Contact Information
MA Prefixes: RRK or RKN
ACA Prefixes: YBD, YBG, YBS, YBM, YBT, YBX, YJV, YJW, YJJ or YJT
MA/ACA Plan Members Medical Service, Procedure, or Equipment Fax Requests: (877) 549 - 1744
MA Plan Member Part B Medication Fax Requests: (816) 398 - 6547
ACA Plan Member Medication (Medical Benefit) Fax Requests: (816) 995 - 1597
MA/ACA Plan Members Medical Service, Procedure, or Equipment Mail-in Requests:
Central Operations (COPS) Blue KC MA & ACA
P.O. Box 419169
Kansas City, MO 64141