Prior Authorization Updates

How to Enhance Your Prior Authorization Experience in 2025

Blue KC wants to help you ensure a smooth transition to our enhanced online prior authorization process that is coming on January 1, 2025. Before 2025 arrives, we encourage you to have a Blue KC Provider Portal account, so you can take advantage of this online process that helps provide accurate requirements for each patient and improved response times.

Effective January 1, 2025, you will not be able to access our online prior authorization submission experience without a Blue KC Provider Portal account. If you do not have an account, please select “Create Account” on our Provider Portal login page at Providers.BlueKC.com and follow the steps.

Blue KC Speeds up Prior Authorization Process on Provider Portal

How would you like to have your prior authorization automatically approved in a matter of minutes? This is now possible for many of our prior authorizations with a new automated, evidence-based system to facilitate the process. Here’s how the process works:

• Submit an electronic prior authorization request on the Blue KC Provider Portal at Providers.BlueKC.com. (Once you log in and arrive on the home page, click on “Prior Authorization.”)
• Select the appropriate guideline and document the patient’s clinical indications to support the request.
• Blue KC will automatically notify you of the authorization determination.

After the electronic prior authorization is submitted, if more information is needed, you may be asked to submit medical records. We encourage you to speak with your Provider Account Executive to learn more about this faster prior authorization process and welcome your feedback.

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Medical Policy Updates

The most up-to-date Medical Policies can be found by logging into Providers.BlueKC.com and clicking on the Medical Policies section. While on that web page, you can also find a link to view Milliman Care Guidelines (MCG), which complement our Blue KC policies.

The Blue KC Medical Policy encompasses internal Blue KC Medical Policy, Blue Cross Blue Shield Association derived Medical Policy and policies adopted from our vendor partners, such as Avalon, MCG and eviCore.

New Policy
Effective date – 1/1/2025	ID: 6.01.68 Title: Irreversible Electroporation of Tumors Located in the Liver, Pancreas, Kidney or Lung Irreversible electroporation is considered investigational for treatment of primary or metastatic solid tumors, including but not limited to, tumors of the liver, pancreas, kidney or lung.

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Payment Policy Updates

Correct Coding Updates Notice

To ensure our members are receiving appropriate care, Blue KC will be implementing the following updates to our claims editing software.

• Effective January 1, 2025, Blue KC will deny claims when ICD-10-CM diagnosis codes are inconsistent with the patient’s age, per Payment Policy POL-PP-45 Lyric (formerly ClaimsXten) Editing.
  • The payment policy states the following:
    • Age Rule: This claim editing logic identifies when an age specific procedure code is reported for a patient whose age falls outside the designated age range for a procedure and/or diagnosis code that is submitted. Age designations are assigned to select codes based on code descriptions or on publications and guidelines from sources such as professional specialty societies, CMS, and the AMA. When an age inconsistency is identified on a claim, the code(s) in question will be denied.
• Effective January 1, 2025, Blue KC will deny therapy services that are not billed with the correct corresponding therapy modifier (GP, GO or GN), per Payment Policy POL-PP-108 Modifiers.
  • This policy is based on the Medicare Claims Processing Manual: Chapter 5 (Part B Outpatient Rehabilitation and CORF/OPT Services), Section 20 – B, Applicable Outpatient Rehabilitation HCPCS Codes.
  • In addition, CMS Transmittal 3670 (CR 9698) states, “Original Medicare claims processing systems contain edits to ensure claims for the evaluative procedures furnished by rehabilitative therapy clinicians – including physical therapists, occupational therapists and speech-language pathologists – are coded correctly. These edits ensure that when the codes for evaluative services are submitted, the therapy modifier (GP, GO or GN) that reports the type of therapy plan of care is consistent with the discipline described by the evaluation or re-evaluation code. The edits also ensure that Functional Reporting occurs, i.e., that functional G-codes, along with severity modifiers, always accompany codes for therapy evaluative services.”

Echocardiography

The following updates to the National Correct Coding Initiative Edits section of Payment Policy POL-PP-196 Echocardiography became effective on December 1, 2024:

• The National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE) allows 1 echocardiography per day when performed by the same provider or same provider group. This “per day” edit is based on clinical benchmarks. If claim denials based on these edits are appealed, adequate documentation of medical necessity must be submitted.
• NCCI also has correct coding initiative conflicts between distinct types of echocardiography’s billed on the same day by the same provider or same provider group.
• Example: 93350 and 93306 were submitted by the same provider on the same date of service. There is a correct coding initiative conflict between these codes based on CPT procedure code definition.
• Guidelines say it is medically inappropriate and contradicts CPT descriptors to submit CPT 93306, 93307 or 93308 performed in conjunction with CPT 93350, as 93350 includes a 93306, 93307 or 93308 service.
• If claim denials based on the edits are appealed, you must submit adequate medical necessity documentation.

Chiropractic and Osteopathic Care

The following updates to Payment Policy POL-PP-212 for Chiropractic and Osteopathic Manipulative Services will become effective on January 1, 2025:

• Removed redundant information on timed therapeutic procedures.
• Added link to payment policy.
• Note: Chiropractors are required to use modifier GP in Always Therapy codes.

Ambulatory Continuous Glucose Monitoring

The following updated guidelines to Payment Policy POL-PP-210 for Ambulatory Continuous Glucose Monitoring (CGM) will be become effective on January 1, 2025:

• Separate reimbursement will not be made for CPT code 95251 for the review of home CGM data.
• Reimbursement would be made by billing the appropriate level of Evaluation and Management (E&M).
• CPT code 95250 is used when the patient is set up with a device that he or she doesn’t own and is provided by a covered healthcare provider.

COVID-19 Billing and Coding

The following updates to Payment Policy POL-PP-225 for COVID-19 Billing and Coding will be effective on January 1, 2025:

• Diagnosis for asymptomatic patient with no confirmed (or suspected) exposure to COVID-19 w/ negative or unknown results from Z20.822 to Z11.52, based on ICD-10-CM Official Guidelines for Coding and Reporting FY 2024.

Bariatrics and B-12 Injections

The following updates to Payment Policy POL-PP-220 for Bariatrics and B-12 Injections will be effective on January 1, 2025:

• CPT codes were added to the table for testing, and treatment of B12 deficiency was added.
• No change in content was made.

End of the Year Reminder: In-Network Skilled Nursing Facility Gold Card

Payment Policy POL-PP-249 for Skilled Nursing Facility Gold Card became effective July 15, 2024, and applies to Commercial, Blue Medicare Advantage and Small Group ACA. Here are more details:

• During the COVID-19 public health emergency, Blue KC waived prior authorization for admission to in-network Skilled Nursing Facilities (SNF). This policy was known as the SNF Waiver of Prior Authorization. Blue KC is formalizing this move with the creation of the Gold Card Payment Policy, which follows the same guidelines.
• Gold carding is part of the “Prior Authorization and Utilization Reform Principles” (PDF) that came out of an AMA-convened workgroup with 16 state and specialty medical societies, national provider associations and patient representatives.
• In line with the AMA’s effort to reduce the volume of prior authorization requests, Blue KC will not require a prior authorization for admittance to SNFs. Notice of admission will still be required, per terms of the facility contract and member certificate. All SNF admissions are subject to concurrent review for ongoing medical necessity, per Blue KC Utilization Management protocol.
• To view this payment policy, visit Providers.BlueKC.com, and click on Go to Payment Policies. The policy will be included in the “New Payment Policies (published within the last 30 days)” section. More details are also featured in the SNF Gold Card article on our Provider Portal home page under Recent News.

End of Year Reminder: Medically Unlikely Edits (MUE)

Blue KC wants to remind you that our Payment Policy Medically Unlikely Edits (MUE) became effective July 1, 2024.

• In November 2023, Blue KC updated language in the National Correct Coding Initiative (NCCI) Payment Policy under MUEs to say, “Blue KC may pay units of service in excess of the MUE value if documentation of medical necessity is submitted.”
• Effective July 1, 2024, for Commercial, ACA QHP for Individual/Family and Small Group ACA lines of business, MUEs with an MUE Adjudication Indicator (MAI) of 3 are reimbursed up to the allowed amount found on the NCCI MUE table. Units billed in excess of the allowed amount will be denied.
  • For our Blue Medicare Advantage line of business, a written inquiry with documentation clearly explaining the medical necessity for the excess units is still appropriate. A statement merely indicating that the patient required additional units is not acceptable.
• MUEs assigned an MAI of 3 are based on criteria (e.g., nature of service, prescribing information) combined with data such that it would be possible but medically highly unlikely that higher values would represent correctly reported medically necessary services.
  • For Commercial, ACA QHP for Individual/Family and Small Group ACA lines of business, a formal appeal with documentation clearly explaining the medical necessity for the excess units is still appropriate. A statement merely indicating that the patient required additional units is not acceptable.
• To view this new payment policy, go to the log-in page at Providers.BlueKC.com and click on Go to Payment Policies. This policy is included in the “New Payment Policies (published within the last 30 days)” section.

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Pharmacy Policy Updates

Biosimilar Products to Replace Humira Effective January 1, 2025

To maintain our commitment to providing our members with the most effective therapies at the lowest possible cost, Blue KC will no longer cover Humira for most commercial members effective January 1, 2025, but we will cover the following three biosimilars:

Simlandi

Adalimumab-adbm (Unbranded Cyltezo)

Amjevita (Nuvaila)

• Biosimilars are highly similar and have no clinically meaningful difference from existing biological reference products.
• Members affected by this change will receive a letter informing them to contact their physician to request a new prescription.
• All specialty drugs require prior authorization (PA). All active PAs for Humira will automatically be applied to the biosimilars listed above for the remainder of the approval time left on the PA.
• If a patient chooses to continue Humira, the patient will be responsible for the majority of the medication cost.

2025 Coverage Change for Obesity Diagnosis

Effective January 1, 2025, and upon a member’s plan renewal, Blue KC wants to inform providers that we will begin covering office visits and labs with standard copays/deductible when a member is given a primary diagnosis of obesity. This change will impact Employer Groups who do not cover weight loss services under their current plan.

The benefits of this change include:

• Ensures that Blue KC makes it easier for members to receive a diagnosis and take care of their health.
• Aligns with 2024 expansion of nutritional counseling benefit.
• Advances member wellness by combining coverage for obesity diagnosis and labs with coverage for nutritional counseling.

Commercial Formulary Updates

We want to let our contracted providers know of updates to the Blue KC Commercial Prescription Drug Lists that will go into effect on January 1, 2025.

Below are the Premium Prescription Drug List updates that will be effective January 1, 2025:

Please Note: These changes ONLY apply to members on the Premium Formulary; Group-specific benefit exceptions may apply.

New Step Therapy Requirements

Members must try preferred alternatives before other drugs will be covered.

Drug Class	Drugs Requiring a Trial of Alternative(s)	Preferred Alternatives (Try First)
Antibiotics	Avidoxy tablet 100 mg	Any of the following generics: doxycycline, minocycline
	Mondoxyne NL capsule 100 mg
Ophthalmic Nonsteroidal Anti-Inflammatory (NSAIDs)	bromfenac soln 0.07%	Any one of the following generic ophthalmic solutions: diclofenac, flurbiprofen, ketorolac

Tier Changes Affecting Member Copayment

Medications Moving to a Lower Tier
Auryxia tablet	Omvoh SC injection	Sotyktu tablet
Taltz SC injection
Medications Moving from Tier 2 to Tier 3
Mulpleta tablet 3 mg	Nutropin AQ

Specialty Drug Classification Changes

New pharmacy restrictions and copay changes may apply.

Now Classified as Specialty Drugs
Leukeran tablet	Filsuvez gel
No Longer Classified as Specialty Drugs
Palforzia packet

New Excluded Drugs with Covered Generic Equivalents

Apokyn inj 10 mg/mL	Celontin cap 300 mg	Compro sup 25 mg	Dantrium cap 25 mg
Doral tablet 15 mg	Fareston tablet 60 mg	Isatol sol 0.5%	Lanoxin tablet
Mestinon solution 60 mg/5 mL	Nexium granules DR 10 mg, 20 mg, 40 mg	Parnate tablet 10 mg	Prezista tablet 600 mg, 800 mg
Proctosol HC cream 2.5%	Proctozone cream HC 2.5%	Proglycem sus 50 mg/mL	Promethegan sup 12.5 mg, 25 mg
Rectiv ointment 0.4%	Samsca tablet	Vigadrone packet	Votrient tablet

New Excluded Medications with Alternatives

Drug Class	Excluded Medications	Covered Alternative
Acne Agents	clindamycin phosphate-tretinoin gel 1.2-0.025%	clindamycin together with tretinoin
	tazarotene gel 0.1%	tazarotene cream
Androgens	testosterone gel 1.62%	testosterone gel (generic Androgel)
Antidiabetic Agents	Victoza injection 18 mg/3mL	Bydureon BCise inj, Byetta inj, Mounjaro inj, Ozempic inj, Rybelsus tab, Trulicity inj
Antifungal Agents	naftfine gel 2%	ciclopirox cream, terbinafine cream, clotrimazole cream
Corticosteroids	budesonide tab ER 9 mg	mesalamine DR capsule 400 mg
Immunological Agents	Humira, Cyltezo, Hyrimoz	adalimumab-adbm (manufactured by Boehringer Ingelheim), Amjevita (manufactured by Nuvaila), Simlandi
Ophthalmic Agents	timolol mal sol 0.25%	timolol ophthalmic solution (generic Timoptic)
	timolol mal sol 0.5%
Phosphate Binders	lanthanum chew	sevelamer tablet
	Velphoro chewable tablet 500 mg	calcium carbonate tab, calcium acetate tab, lanthanum carbonate chew tab, sevelamer carbonate tab, sevelamer HCl tab, Auryxia tab

Below are the Select Prescription Drug List updates that will be effective on January 1, 2025:

Please Note: These changes ONLY apply to members on the Select formulary. Group-specific benefit exceptions may apply.

New Step Therapy Requirements

Members must try preferred alternatives before other drugs will be covered.

Drug Class	Drugs Requiring a Trial of Alternative(s)	Preferred Alternatives (Try First)
ADHD Agents	Adderall tablet	Any three of the following generics: amphetamine-dextroamphetamine IR/ER, dexmethylphenidate IR/ER, dextroamphetamine SR/IR, methylphenidate IR/ER, lisdexamfetamine
Antibiotics	Avidoxy tab 100 mg	Any one of the following generics: doxycycline, minocycline
	Monodoxyne NL cap 100 mg
Genitourinary Agents	Velphoro chewable tablets 500 mg	Any two of the following generics or preferred brands: calcium carbonate, calcium acetate, lanthanum carbonate, sevelamer carbonate, sevelamer HCl, Auryxia
Ophthalmic Nonsteroidal Anti-Inflammatory (NSAIDs)	bromfenac soln 0.07%	Any one of the following generic ophthalmic solutions: diclofenac, flurbiprofen, ketorolac

Tier Changes Affecting Member Copayment

Medications moving from Tier 3 to Tier 2
Omvoh inj 100 mg/mL	Sotyktu tab 6 mg	Taltz
Medications moving from Tier 2 to Tier 3
Levemir FlexPen	Levemir inj 100 units/mL	Mulpleta tab 3 mg
Nutropin AQ pen	Victoza inj 18 mg/3mL

Specialty Drug Classification Changes

New pharmacy restrictions and copay changes may apply.

Now Classified as Specialty Drugs
Leukeran tablet	Filsuvez gel
No Longer Classified as Specialty Drugs
Palforzia packet

New Excluded Medications with Alternatives

Drug Class	Excluded Medications	Covered Alternative
Acne Agents	clindamycin phosphate-tretinoin gel 1.2-0.025%	clindamycin together with tretinoin
	tazarotene gel 0.1%	tazarotene cream
Androgens	testosterone gel 1.62%	testosterone gel (generic Androgel)
Antifungal Agents	naftifine gel 2%	ciclopirox cream, terbinafine cream, clotrimazole cream
Corticosteroids	Uceris tablet ER 9 mg, budesonide tab ER 9 mg	mesalamine DR capsule 400 mg
Growth Hormones	Humatrope	Omnitrope, Nutropin AQ, Norditropin, Skytrofa, Ngenla
	Sogroya injection
Immunological Agents	Humira, Abrilada, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Yuflyma, Yusimry	Adalimumab-adbm (manufactured by Boehringer Ingelheim), Amjevita (manufactured by Nuvaila), Simlandi
Ophthalmic Agents	timolol mal soln 0.25%	timolol ophthalmic solution (generic Timoptic)
	timolol mal soln 0.5%
	Timoptic soln 0.5%
Opioid Analgesics	Nucynta ER tablet	hydrocodone ER, hydromophone ER, Hysingla ER, oxymorphone ER, morphine ER, Oxycontin
Phosphate Binders	lanthanum chew	sevelamer tablet
Respiratory Agents	Advair Diskus	Advair HFA, Breo Ellipta, Symbicort

New Excluded Drugs with Covered Generic Equivalents

Ampyra tablet	Anusol-HC cream	Apokyn inj 10 mg/mL	Celontin cap 300 mg
Cetrotide inj 0.25 mg	Clobex shampoo 0.05%	Compro sup 25 mg	Copaxone inj
Dantrium cap 25 mg	Doral tablet 15 mg	Esbriet capsule	Esbriet tablet
Evekeo tablet	Fareston tablet 60 mg	Forteo inj	Istalol soln 0.5%
Lanoxin tablet	Latuda tablet	Lialda tablet	Mestinon soln 60 mg/5mL
Nexium granules DR 10 mg, 20 mg, 40 mg	Onglyza tablet 5 mg	Parnate tablet 10 mg	Plavix tablet 75 mg
Prezista tablet 600 mg, 800 mg	Proctosol HC cream 2.5%	Proctozone cream HC 2.5%	Proglycem sus 50 mg/mL
Promethagan supp 12.5 mg, 25 mg	Proventil HFA	Qudexy XR capsule	Rectiv ointment 0.4%
Samsca tablet	Tobi solution 300 mg/5 mL	Trokendi XR capsule	Votrient tablet

Below are the Essential Health Benefits (EHB) Prescription Drug List updates that will be effective on January 1, 2025.

Please Note: These changes ONLY apply to members on the EHB Formulary. Group-specific benefit exceptions may apply.

The following tables report the impact of PDL changes to the most utilized medications.

New Excluded Medications with Alternatives

Drug Class	Excluded Medications	Covered Alternative
ADHD Agents	Vyvanse cap, Vyvanse chewable tab	lisdexamfetamine cap, amphetamine IR/ER, amphetamine/dextroamphetamine IR/ER, dexmethylphenidate IR/ER, atomoxetine, clonidine, guanfacine
Antidiabetic Agents	Victoza	BCise, Byetta, Bydureon, Mounjaro, Trulicity
	liraglutide
Immunomodulators	Humira, Cyltezo, Hyrimoz	adalimumab-adbm (manufactured by Boehringer Ingelheim), Amjevita (manufactured by Nuvaila), Simlandi
Inhaled Corticosteroids	Flovent diskus	Arnuity Ellipta, fluticasone propionate diskus, Qvar RediHaler,
	Pulmicort Flexhaler

Tier Changes Affecting Member Copayment

Medications Moving to a Lower Tier
alprazolam ER 1 mg	amitriptyline hcl tab 10 mg, 25 mg, 50 mg	armodafinil tab	atomoxetine hcl cap 10 mg, 18 mg, 25 mg
Doxepin cap 10 mg, 50 mg	eletriptan tab	fenofibrate cap	fluvoxamine tab 50 mg, 100 mg
glyburide/metformin hcl tab	linezolid tab	neomycin/polymyxin/hc soln 1% otic	neomycin/polymyxin/hc susp 1% otic
sumatriptan nasal spray	sumatriptan auto-injector	zolmitriptan ODT	zolpidem tartrate ER

Medications Moving to a Higher Tier
brimonidine sol 0.1%	brimonidine/timolol sol 0.2/0.5%	cyclosporine emu 0.05% OP	cyclosporine cap 25 mg, 100 mg
fluticasone prop/salmeterol diskus	levocarnitine sol 1 gm/10 mL	levocarnitine tab 330 mg	lisdexamfetamine cap
lisdexamfetamine chewable tab	mycophenolate cap 250 mg	mycophenolate tab 500 mg	mycophenolic DR tab
sumatriptan inj 6 mg/0.5 mL	tacrolimus cap	tafluprost sol 0.0015%	Wixela Inhub

Preferred Product Changes (Medical Drugs)

Effective January 1, 2025, Blue KC will be making changes to preferred products in several medical benefit drug categories. (The following list is not inclusive of all preferred products. These are CHANGES ONLY. *Any additional codes or new biosimilars/products within these classes will automatically be non-preferred unless otherwise noted*)

Infliximab		1/1/2024	1/1/2025
AVSOLA	Q5121	Preferred
INFLECTRA	Q5103		Preferred
INFLIXIMAB	J1745	Preferred	Preferred
REMICADE	J1745	Preferred	Preferred
RENFLEXIS	Q5104

Trastuzumab		1/1/2024	1/1/2025
HERZUMA	Q5113
KANJINTI	Q5117	Preferred	Preferred
OGIVRI	Q5114	Preferred
ONTRUZANT	Q5112	Preferred
TRAZIMERA	Q5116		Preferred
HERCEPTIN	J9355
HERCEPTIN HYLECTA	J9356

Rituximab		1/1/2024	1/1/2025
RIABNI	Q5123	Preferred
RUXIENCE	Q5119	Preferred	Preferred
TRUXIMA	Q5115	Preferred	Preferred
RITUXAN	J9312
RITUXAN HYCELA	J9311

Immunoglobulins		1/1/2024	1/1/2025
ALYGLO	J1599	Preferred
ASCENIV	J1554	Preferred
BIVIGAM	J1556	Preferred
CARIMUNE NF	J1566	Preferred
CUVITRU	J1555	Preferred	Preferred
CUTAQUIG	J1551	Preferred	Preferred
FLEBOGAMMA	J1572	Preferred	Preferred
GAMMAGARD	J1569	Preferred	Preferred
GAMMAGARD SD	J1566	Preferred
GAMMAKED	J1561	Preferred	Preferred
GAMMAPLEX	J1557	Preferred	Preferred
GAMUNEX-C	J1561	Preferred	Preferred
HIZENTRA	J1559	Preferred	Preferred
HYQVIA	J1575	Preferred	Preferred
OCTAGAM	J1568	Preferred	Preferred
PANZYGA	J1576	Preferred	Preferred
PRIVIGEN	J1459	Preferred	Preferred
XEMBIFY	J1558	Preferred	Preferred

IV Iron		1/1/2024	1/1/2025
FERAHEME	Q0138	Preferred	Preferred
FERRLECIT	J2916	Preferred	Preferred
INFED	J1750	Preferred	Preferred
INJECTAFER	J1439	Preferred
MONOFERRIC	J1437	Preferred
VENOFER	J1756	Preferred	Preferred

*IV Iron - No PA for preferred products

New Pharmacy Policies

Below are new Blue KC pharmacy policies that impact our Commercial and ACA lines of business and require prior authorization:

Effective 11/1/24

New Pharmacy Policies
Policy Number	Policy Name	Summary
5.02.665	Anktiva (nogapendekin alfa inbakicept-pmln)	FDA Approved for Non-Muscle Invasive Bladder Cancer (NMIBC) with Carcinoma in situ (CIS); intravesical; Medical-Rx benefit

Effective 12/1/24

New Pharmacy Policies
Policy Number	Policy Name	Summary
5.02.668	Imdelltra (tarlatamab-dlle)	FDA approved for Extensive-stage small cell lung cancer (ES-SCLC); IV; Medical-Rx benefit

Effective 1/1/25

New Pharmacy Policies
Policy Number	Policy Name	Summary
5.02.666	Parenteral Iron	Requested products are being used for a Food and Drug Administration (FDA) approved indication AND Patient has had intolerance or unsatisfactory response to oral iron. Preferred agents will be Feraheme, Ferrlecit, Infed, and Venofer. Patients must step through all preferred agents before a non-preferred agent. Only the non-preferred agents (Injectafer, Monoferric) will be set up to require PA.
5.02.669	Rytelo (imetelstat)	FDA approved for Myelodysplastic Syndrome (MDS) with Transfusion Dependent Anemia; IV; Medical- Rx benefit

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Medicare Advantage Updates

Medicare Advantage Exit Helpful Information

Blue KC made the difficult decision to exit the Medicare Advantage (MA) market at the end of 2024. We are providing the information below to answer questions you may have regarding the change.

• How does this impact Medicare Advantage members who belong to another Blue Cross and Blue Shield affiliate (e.g., Blue Cross Blue Shield of Michigan) but reside in the Blue KC service area?
  • These members may continue to seek care within the Blue KC service area.
  • In many of these cases, the member’s plan will apply in-network benefits to an out-of-network claim.
  • You will want to check benefits and eligibility prior to providing services for a member.
  • Blue KC will continue to support these members through the following:
    • Provider education
    • Notification of quality-of-care opportunities
    • Collection of medical records
• What impact does this have on provider reimbursement?
  • The member’s plan is responsible for setting and determining the reimbursement.
  • Providers can expect to be reimbursed at standard Medicare rates.
  • The allowable charge will be determined based on Medicare rates.
• How will transition of care be handled?
  • Transition of care outreach for new members is the responsibility of the new MA carrier.
  • Patients may not respond to those communications. We encourage providers to be proactive by obtaining any new prior authorization or insurance information beginning on January 1, 2025.
  • Please be attentive to any prior authorization requirements for either Medical, Surgical and/or Pharmacy that must be reinitiated. In addition, Durable Medical Equipment (DME) or Skilled Nursing Facility (SNF) needs will likely need to be recertified.
  • The only service that extends beyond December 31, 2024, is acute inpatient care, which is covered until discharge.
• How will this affect the Blue KC Medicare Supplement line of business?
  • Blue KC’s MA exit does not have any impact on Medicare Supplement.
  • When communicating with your patients, please verify if they are inquiring about Medicare Supplement.
  • Blue KC Medicare Supplement members carry a member ID card that looks similar to the card template on the right.

Proper Documentation for Cancer Diagnosis: Active, History or in Remission?

Cancer diagnoses are commonly misreported due to a lack of supporting documentation within the medical record. The Office of Inspector General (OIG) is scrutinizing the medical record documentation of encounters with cancer diagnosis codes submitted to CMS due to a lack of support that the cancer is active.¹

It takes a team to mitigate the risk of these errors, and it begins with the provider’s documentation practices, including an accurate depiction of cancer diagnoses. Providers should continually reassess and document active and ongoing cancers and avoid adding them to the past medical history (PMH) if the cancer is still under treatment.

If an active, history of or in remission cancer diagnosis impacts your medical decision making, is treated or evaluated during a patient encounter, make sure to include a diagnosis, status and plan (DSP) that ensures accurate diagnoses are submitted on claims.

Active	The patient is currently being treated and managed for cancer. Examples of documentation to support active cancer may include: A cancer has been diagnosed and is awaiting the treatment plan. The cancer is being treated with chemotherapy, radiation therapy or anti-neoplastic drug therapy. Affirmation of current disease management. A patient refuses therapeutic treatment. Cancer has been diagnosed, but the plan is to watch and wait. The patient is currently on adjuvant therapy (e.g., Lupron or Tamoxifen) and there is evidence of cancer. The cancer has been removed fully or partially and the patient is receiving ongoing treatment.
History	The patient was previously diagnosed with cancer, which was successfully treated and is no longer receiving treatment. Examples of documentation that supports a prior, personal history of cancer may include: Cancer has been eradicated/excised and no further treatment is directed to that site. The patient has a history of cancer that was successfully treated. History of cancer – continue surveillance of recurrence. The patient is currently on adjuvant therapy (e.g., Lupron or Tamoxifen) for prophylaxis and no evidence of disease is indicated.
In Remission	Make sure to document if a cancer is in remission as certain cancers have in remission codes such as leukemia and multiple myeloma.

Appropriate Coding for Cancer Diagnoses²

If a provider’s documentation supports a historical cancer diagnosis that impacts the current encounter, use a diagnosis code from section Z85.- for the personal history of a specific type of cancer.

If a provider’s documentation supports that cancer is in-remission, review the ICD-10-CM index to confirm accurate code selection. Some cancer diagnoses such as leukemia include specific codes for an in-remission status.

For active cancer diagnoses that are supported by documentation, refer to the ICD-10-CM Neoplasm Table in the index. Review documentation to assess if the cancer is considered malignant primary (originating site of cancer) or malignant secondary (the location a cancer has spread or metastasized to is different than the originating site of cancer). For example, documentation that states “Colon cancer post subtotal colectomy continuing treatment with chemotherapy has metastasized to liver. Pending oncology treatment plans” would be coded with C18.9 Malignant neoplasm of colon, unspecified and C78.89 Secondary malignant neoplasm of other digestive organs.

Sources:

¹https://oig.hhs.gov/oas/reports/region2/22001009.asp
² https://www.cms.gov/files/document/fy-2024-icd-10-cm-coding-guidelines-updated-02/01/2024.pdf

Medicare Annual Wellness Exam Requirements

The purpose of the Initial Preventative Physical Examination (IPPE), the Initial Annual Wellness Visit (AWV) and the Subsequent Annual Wellness visit (AWV Sub) is to allow the provider to have a conversation with their patient to address current conditions and address any future healthcare needs.

Medicare Annual Wellness Exam Requirements3
Element	Included	IPPE G0402	AWV G0438	AWV Sub G0439
Health Risk Assessment (provider or patient completed)	Demographic data, health status self-assessment, psychosocial risks, behavioral risks, ADLs, and instrumental ADLs		X	X
Past Medical, Family and Social History	Past medical and surgical history, current medications and supplements, family history, diet, physical and social activities, alcohol, tobacco, and illegal drug use history	X	X	X
Current Providers and Suppliers	Current providers and suppliers providing medical care for patient		X	X
Potential Depression Risk Factors	Current or past experiences with depression, other mood disorders and completed standardized screening tool	X	X	X
Functional Ability and Safety Level	ADL's, fall risk, hearing impairment, home and community safety	X	X	X
Examination	Height, weight, BMI, blood pressure, balance and gait, visual acuity screen, other factors deemed appropriate based on clinical standards	X
Measurements	Height, weight, BMI, blood pressure, other routine measurements as appropriate		X	X
Cognitive Impairment Screening	Direct observation or reported observations from patient or others to assess cognitive function		X	X
Establish/Update Preventive Screening Schedule	Schedule based on checklist for the next 5-10 years, clinical recommendations, and results of wellness visit		X	X
Establish/Update List of Risk Factors and Conditions	Include recommendation for primary, secondary, or tertiary interventions, mental health conditions and cognitive impairments, IPPE risk factors or identified conditions, treatment options and associated risks and benefits		X	X
End-of-Life Planning (patient's discretion)	Discussion includes their ability to prepare an advance directive, agreement on following the advance directive, psychiatric advance directives	X	X	X
Current Opioid Prescriptions (if applicable)	Potential opioid use disorder risk factors, pain severity and treatment plan, non-opioid treatment options, specialist referral as appropriate	X	X	X
Substance Use Disorder Screening	Review potential SUD risk factors and make referrals as appropriate	X	X	X
Educate, Counsel, and Refer	Based on results of visit or necessary preventive services, provide education, counseling and referrals	X	X	X
Social Determinants of Health (SDOH) Risk Assessment	Assessment follows standardized, evidence-based practices and ensure communication aligns with the patient's educational, developmental, and health literacy levels, as well as being culturally and linguistically appropriate		X	X

Note: When these codes are billed in conjunction with an evaluation and management (E/M) service, append modifier 25 to the E/M service code.

Sources:

³ https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html#IPPE

2024 STARS Quality Incentive Program Reminder

As the 2024 STARS Quality Incentive Program year is about to end, please remember that all non-standard documentation that supports quality gap closure or an exception must be submitted by January 15, 2025. Final program reporting will be delivered in June of 2025. We greatly appreciate the collaboration in improving the quality of care for our Blue Medicare Advantage members.

One quality measure to monitor closely in the last quarter of the year is medication adherence, as compliance rates can drop quickly. Adherence to medications is crucial to help mitigate long term complications or exacerbations of your patients’ chronic illnesses.

For patients on medications for diabetes, hypertension or high cholesterol, ensure they understand the importance of adhering to their prescriptions.

Regularly discuss potential barriers the patient may encounter when filling a medication, such as cost, forgetfulness or transportation.

Identify opportunities to remove barriers, such as switching to generic medications, writing 90-day prescriptions or switching to a mail order pharmacy.

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Provider Education

Timely Filing and Corrected Claims

Blue KC wants to provide the following helpful information for timely filing and corrected claims:

• Verify insurance and confirm eligibility upon patient arrival to avoid timely filing denials.
• Claims must be submitted no later than 180 days after the date of service to be eligible for payment.
  • Exception: If another Policy paid primary in error and later recoups their payment, you may request we waive Timely Filing within 90 days of notification from the other Policy.
  • Coordination of Benefits: If Blue KC is secondary, the claim must be submitted to the secondary policy within 90 days of the primary policy’s payment date (this includes instances where Blue KC is also the primary policy).
• Claim adjustments and corrected claims must be submitted within 12 months of the original paid date for claims previously processed by Blue KC.
• For more details on timely filing, log in to your account at Providers.BlueKC.com, and click on “Resources”. Timely filing is featured on page 5 in the Claims, Billing and Remittance section of our Provider Reference Guide.

Verify Your Information Through CAQH Attestation

The Consolidated Appropriations Act (CAA) requires group health plans and issuers offering group and individual health plans to establish a verification process to confirm directory information at least every 90 days.

• Delegated Providers attest through monthly roster submission.
• Non-Delegated Providers must attest quarterly through CAQH Proview.

Blue KC, along with CMS and NCQA, require providers to attest their data in CAQH every 90 days, and it’s a requirement in our credentialing process. Lack of quarterly attestation will result in the provider being suppressed from the Blue KC Directory and could lead to provider termination.

Advanced Practice Provider Credentialing Reminder

In order to comply with CMS, Blue KC wants to remind you that all Advanced Practice Providers (APPs), which were previously called Mid-Level Practitioners, must be credentialed with Blue KC. This updated provider credentialing policy became effective on January 1, 2022. APPs include, but are not limited to:

Nurse Practitioners	Clinical Nurse Specialists
Nurse Midwives	Physician Assistants

• To apply for credentialing, APPs should click here.
  • Don’t forget that all APPs are required to provide Supervising/Sponsoring Physician information.
• After updating your credentialing information on the CAQH website, please fill out the appropriate Blue KC Credentialing Application. To find this form, log on at Providers.BlueKC.com, click on “Forms” under “Quick Links” on the home page and look under the “Provider Services” section.
• We require credentialing for all APPs who provide and bill for professional services in practice settings, including, but not limited to:
  • Clinics (Primary Care and/or Specialist)
  • Retail Health Clinic
  • Urgent Care Facilities
  • Walk-in Clinics
  • Claims must be submitted under the rendering provider. Blue KC does not allow incident-to-billing for APPs.
  • Note: Non-contracted Groups with affiliated APP(s) must submit the Blue KC Network Interest Form before providers can be considered for credentialing. To find this form, visit the Blue KC Provider Portal log-in page at Providers.BlueKC.com and click “Join Blue KC Networks.”

  Process for Unsolicited Checks

  To help reduce the administrative cost for providers, Blue KC will no longer accept unsolicited checks effective January 1, 2025. If you have identified a potential overpayment, you can submit a request for review of possible overpayment and check “Overpayment” on our Claim Inquiry form. To find this form, log on at Providers.BlueKC.com, click on “Forms” under “Quick Links” on the home page and look under “Claim Forms.” Any unsolicited check received will be returned to the provider requesting a claim inquiry for review of potential overpayment.

  In filling out the details on the form, providers can include the claim information and reasons they feel the claim is overpaid. If the potential overpayment is valid, Blue KC will offset the claim to recoup the overpayment. If you do not receive frequent payments (two or more monthly payments in a three-month time span), we will respond to the claim inquiry form by letting you know that we will send you an overpayment letter for you to send back to us with the payment.

  If you have not yet set up Electronic Funds Transfer (EFT), you can submit an EFT Application Form. To find this form, log on at Providers.BlueKC.com, click on “Forms” under “Quick Links” on the home page and look under the “EFT/ERA Enrollment Forms” section. To set up the EFT, you may not have any uncashed checks from Blue KC over 30 days old.

  Claim Tips

  Blue KC is seeing a recent pattern of Home Health Agencies (HHA) who are incorrectly billing the assessment date as the start date of the claim. We want to remind HHAs that the assessment date is an occurrence code and should not be used as the statement from date since no services are billed for that date.

  Below are the current acceptable Type of Bill (TOB) codes per CMS:

  TOB Codes
  0322	0327	0329
  032Q	0332	0337
  0339	033Q	034X

  Per the CMS billing manual, the Q code must be billed on the first date of service with the corresponding therapy service and same revenue code. For updates, it is important to review the CMS guidelines, which are published online.

  Provider Form Assistance

  To access our Blue KC provider forms, log into Providers.BlueKC.com and click on Forms under Quick Links on the home page. Use the table below to help you use the correct form. For questions about the Provider Updates Form, email Provider_Data@BlueKC.com. For credentialing form questions, email Credentialing.Status@BlueKC.com.

  Form	Description
  Provider Updates	To submit provider updates to Blue KC in between the initial credentialing and re-credentialing cycles. Updates include changes to rendering practitioners, service locations or group/facility information. Note: Updates cannot be made from a claim form. You just use the Provider Updates form to communicate any changes to Blue KC. If you are updating the rendering practitioner information, please ensure the practitioner has attested to CAQH in the last 30 days.
  Initial Credentialing Application – Solo Providers/Rendering Practitioners	New solo/individual practitioners who bill Blue KC directly for rendering services to our members. The Solo/Individual Practitioner does not belong to a group or facility and is new to providing services to Blue KC. New Rendering Practitioner who is affiliated with a Group or Facility and must be credentialed by Blue KC. Blue KC requires the new Individual or Rendering Practitioner to attest to CAQH within 30 days of submission of this form.
  Initial Credentialing Application – Ancillary	Groups who offer supportive healthcare services, such as laboratories, radiology centers, or medical equipment suppliers but do not have rendering practitioners must be credentialed to support Blue KC networks.
  Initial Credentialing Application – Facility	New Facilities who offer medical services, such as Hospitals, Health Care Agencies, Clinics, Nursing Homes, Rehabilitation Centers, or Ambulatory Surgical Centers, must be credentialed by Blue KC.
  Revalidation Application – Solo Providers/Rendering Practitioners	Existing Individual Practitioners (Solo Providers) who bill Blue KC directly for rendering services to our members must be re-credentialed every 3 years. Rendering Practitioners who are affiliated with a Group or Facility and must be re-credentialed every 3 years. Submit the corresponding CAQH attestation within 30 days prior to submitting this form.
  Revalidation Application – Ancillary	Groups who offer supportive healthcare services, such as laboratories, radiology centers, or medical equipment suppliers but do not have to render practitioners that must be re-credentialed every 3 years.
  Revalidation Application – Facility	Existing Facility Provider Re-validation must be done every 3 years. This form can be utilized by existing Facility providers who offer medical services, such as Hospitals, Health Care Agencies, Clinics, Nursing Homes, Rehabilitation Centers, or Ambulatory Surgical Centers.

  Blue KC Primary Care First Program Surpasses $100 Million in Total Savings over Three Years

  What if there was a way for a health insurance company to create a program that addresses the rising costs of healthcare for its members, doctors, providers, hospitals and employers?

  Blue KC has found a solution thanks to its patient-focused care program that helps people get healthy faster and stay healthy longer, while keeping healthcare more affordable.

  Blue KC’s groundbreaking Primary Care First (PCF) program improved quality of care for patients and saved more than $50 million in healthcare costs for members attributed to the program’s participating providers in 2023, helping curtail the impact of medical cost inflation for members and small and large businesses. The Blue KC PCF program, which was the first of its kind locally when it was established in 2010, has achieved total savings of $125 million in the last three years.

  Blue KC’s PCF is recognized as one of the most rapid and comprehensive shifts to patient-focused care in the nation by any health plan. Participating doctors, providers and hospitals and Blue KC are jointly accountable for meeting quality and cost measures. This approach modernizes healthcare by rewarding quality of care and results in fewer unnecessary hospital admissions and more preventative care.

  Payments to hospitals and doctors are based on improved delivery of care rather than the number of procedures or tests performed. This program works with community providers to build a system where high-quality care is affordable and accessible for all members in Blue KC’s 32-county service area in Greater Kansas City and Northwest Missouri.

  “From all of us at Blue KC, we sincerely thank all the Blue KC PCF participants for partnering with our patient-focused care programs that are transforming healthcare and improving people’s health in our community,” said Erin Stucky, Blue KC President and CEO.

  “Since launching our Medical Home program in 2010, Blue KC has been proud to work with primary care practices across the Kansas City region, and it’s amazing to see how the program continues to help improve the quality of care for their patients while lowering their healthcare costs,” said Dr. Greg Sweat, Blue KC Senior Vice President and Chief Health Officer.

  “Here at Sunflower Medical Group, we have worked closely with Blue KC for many years now, partnering with them on many quality improvement and healthcare transformation efforts,” said Dr. Yvette Guislain Crabtree, Director of Clinical Quality, Sunflower Medical Group. “Our group, along with our many primary care patients, have benefited greatly from this partnership. We look forward to continuing to work with them in the future.”

  Doctors and hospitals participating in Blue KC’s PCF program met their performance goals by delivering high-quality, cost-effective care for the nearly 350,000 members they served in 2023. Members who saw Blue KC PCF providers benefited from enhanced quality of care, including:

  • More consistent screening and treatment of diabetes and high blood pressure.
    • 80% demonstrated control of their diabetes, compared with 55% of members who received services from providers who do not participate in Blue KC PCF.
    • 72% demonstrated control of their high blood pressure, compared with 40% of members who received services from providers who do not participate in Blue KC PCF.
  • Higher rates of preventative care and cancer screenings.
    • 73% were screened for colorectal cancer, compared with 44% of members who received services from providers who do not participate in Blue KC PCF.
  • More children connecting to their PCP or pediatrician for annual well-child visits.
    • 68% of children and adolescents had their annual well-child visits compared with 31% of children and adolescents who received services from providers who do not participate in Blue KC PCF.

  Blue KC PCF doctors, providers and hospitals are advancing and participating in a pathway to value agreements – accountable financially for meeting cost and quality standards.

  • Blue KC is the largest not-for-profit health insurer in Missouri and the only not-for-profit commercial health insurer in Kansas City with coverage options for individuals of all ages, and for businesses of all sizes. The Blue KC PCF program includes doctors, providers and hospitals serving members in our 32-county service area in Greater Kansas City and Northwest Missouri, helping provide critical access to primary care.
  • Blue KC PCF features partnerships with more than 190 primary care practices in our service area. That includes 220 locations with more than 1,800 primary care providers.
  • Health systems and physicians currently in the Blue KC PCF program account for more than 60% of Blue KC’s total medical expenses, excluding prescription drug costs.

  Blue KC Care Management Team – A partner in health

  The Blue KC Care Management Team includes clinical nurses, social workers, Community Health Workers and other healthcare professionals. They can help your patients navigate cancer, offer resources for a healthy pregnancy, manage chronic health conditions, offer support and encouragement after a diagnosis, provide assistance with transition of care, assist patients in achieving their wellness goals and answer health questions. The team personalizes a plan based on each patient’s unique care needs.

  Behind the scenes, the Care Management Team continuously monitors a dashboard, which surfaces insights about preventive health needs, such as flu shots or annual eye exams, and flags patient survey responses related to their health, wellness and nutrition. Our team then works with your patients to schedule care and offer real-time support.

  One of the best ways to connect with the Care Management Team is with the Blue KC Care Management app. Your patients can download it at the App Store, Google Play or by scanning the QR code at Care Management. For more information about case management services or to make a referral, call Management Referral Line toll free numbers 1-800-822-2583 ext. 2060 or 1-866-859-3811.

  Flu Vaccine: Focus on High-Risk Patients

  According to the CDC, flu vaccination decreases the chance of infection, lessens the severity of infection and can reduce the chance of hospitalization. If infected with influenza, individuals with chronic heart conditions or lung disease may experience a worsening of these conditions. Illnesses associated with the flu include pneumonia, bronchitis, and sinus infections¹.

  • Despite being at higher risk of catastrophic outcomes, individuals with heart or lung-related conditions vaccinate for the flu at similar rates to other groups at lower risk.^{2, 3}
  • Blue KC data suggests that high-risk patients with the flu are hospitalized more often, utilizing more resources with more costly outcomes.
  • According to Blue KC data from the 2022-2023 flu season, 80-90% of influenza-related hospitalizations among those identified as having heart or lung-related conditions could be attributed to not being vaccinated.
  • People get flu vaccinations outside the traditional PCP clinic and are looking to pharmacies and specialists for this service.⁴

  How you can help your patients:

  • Contact your patients about getting the flu vaccine.
    • Have flu vaccinations available in your office and share other flu vaccine locations.
  • Explain the risk to your patients of not being vaccinated each year.

  Sources:
  (1) Centers for Disease Control and Prevention [CDC] (2022, September 22). Flu symptoms and complications. Retrieved from https://www.cdc.gov/flu/highrisk/index.htm. (2) Deslandes, R., et al. (2020). Community pharmacists at the heart of public health: A longitudinal evaluation of the community pharmacy influenza vaccination service. Research in Social and Administrative Pharmacy 16(4), 497-502. (3) Centers for Disease Control and Prevention [CDC] (2022, October 26). Flu Vaccination Coverage, United States, 2021–22 Influenza Season. Retrieved from https://www.cdc.gov/flu/fluvaxview/coverage-2022estimates.htm (4) Rodriguez, T (2019, August 27). Managing Influenza as a Coinfection in COPD. Pulmonary Advisor. Retrieved from https://www.pulmonologyadvisor.com/home/resources/lungs-bugs/influenza-in-chronic-obstructive-pulmonary-disease-complications-and-management/

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  Health Equity

  Blue KC Participates in Panel Discussion on the Business Value of Health Equity

  

  To create awareness about how health equity and health disparities directly impact local businesses, Blue KC Medical Director and Department Vice President of Population Health Dr. Ayo Ajaiyeoba joined other Kansas City health ecosystem leaders by participating in the Kansas City Business Journal panel on the Business Value of Health Equity.

  The event was sponsored by the KC Health Equity Learning and Action Network (LAN), a Blue KC partner, and took place on November 8 at the Carriage Club in Kansas City, MO. LAN, a joint effort between KC Health Collaborative and the Health Forward Foundation, is at the forefront of advancing health equity by focusing on solutions that address health disparities.

  Register Now for Implicit Bias Training

  Experience an interactive and innovative implicit bias training that will generate important discussion and help create more equitable outcomes for the communities you serve, while having a chance to earn Continuing Education Credits.

  Sponsored by Blue KC and presented by Dr. Sharla Smith, PhD, MPH, all healthcare professionals are invited to join in person at no cost from 9 a.m. – 11 a.m. on either Tuesday, March 4, 2025, or Wednesday March 12, 2025, at the Union Station Kansas City Board Room. A complimentary breakfast will be served.

  In addition, the Racial Equity Collaborative will lead scripted health scenarios that will enable participants to practice complex conversations and interrupt identified bias recognized by audience members.

  To register, scan the QR code below or click here.

  

  For more information, contact Tia.Kennedy@BlueKC.com or call (816) 395-2598.

  ACCREDITATION STATEMENT

  In support of improving patient care, this activity has been planned and implemented by the University of Kansas Medical Center, which is jointly accredited by the Accreditation Council for Continuing Medication Education (ACCME) and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

  • Physicians: The University of Kansas Medical Center designates this activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • Nurses: The University of Kansas Medical Center designates this activity for a maximum of 2.0 ANCC contact hours.

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  Happy Holidays

  

  As we near the end of 2024, Blue KC wants to wish you Happy Holidays and a healthy New Year! We value and appreciate you as our partner in providing quality care. At Blue KC, we take pride in the fact we’ve been part of the fabric of the Kansas City community for over 85 years. Why Kansas City? The answer is simple: Because it’s home. Blue KC is proud to be your local health insurance partner. Click here to learn more.

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  Provider Portal Enhancements

  Blue KC’s Provider Portal is now better than ever! Our powerful digital tool for providers can be accessed 24/7 with the click of a button! Provider Portal Features include:
  • Search and review claims
  • Submit and view electronic prior authorizations
  • Look up member eligibility and benefits
  • Access Medical and Payment Policies
  • See provider remittances
  • View Provider Reference Guides
  • Check out recent news updates
  • Read BlueSpeak provider e-Newsletter
  • Find helpful provider forms
  • Use dental resources
  • And so much more!

  Blue KC is proud of recent enhancements that were made to the Portal.

  A new-look home page gives you one- to two-click access to core health insurance functions, including member eligibility and benefits, prior authorization, claims inquiry and remittances.

  The new enhancements provide quicker account registration and a much easier prior authorization experience. To learn more, click here to view a written summary and video about each enhancement.

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  Contact Us

  Please join the BlueSpeak email distribution list by sending a request to BlueSpeak@BlueKC.com. You can also use this email address to give us any feedback about BlueSpeak. We would love to hear from you!

  If you have questions about any of these updates, please call the Blue KC Provider Hotline at 816-395-3929 for Commercial line of business, 866-508-7140 for Blue Medicare Advantage line of business or 866-859-3822 for the ACA Provider Hotline. We value and appreciate you as our partner in providing quality care.

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