New Claim Inquiry Form is Here

Blue Cross and Blue Shield of Kansas City (Blue KC) has a new and improved Claim Inquiry Form to better serve you. To find the form, click here or go to the log in page at Providers.BlueKC.com and click on forms. Here’s a summary of the enhancements made to this new version of the Claim Inquiry Form:

• Modernized the look and feel.
• Reorganized with dynamic fields for a more efficient user-experience.
• Eliminated optional fields to streamline input needed from submitter.
• Added a confirmation email that will include a copy of your submission and attachments.
• Refreshed the inquiry confirmation page and email to provide:
  • What to expect?
  • General response times.
  • How to contact the Provider Hotline.

Back to Top

Payment Policy Updates

Laparoscopic Adjustable Gastric Banding (LAGB) – Gastric Band Adjustment

Blue KC wants to inform you that we will have new Payment Policy POL-PP-253 for Laparoscopic Adjustable Gastric Banding (LAGB) – Gastric Band Adjustment that will be effective on April 1, 2025:

• Claims for an adjustment of a gastric restrictive device after the global period (90 days after surgery) may be reimbursable in the office setting with HCPCS codes S2083 adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline.
• An E/M and the adjustment of a gastric band will only be allowed on the same day if there was a significantly separate service provided. Modifier 25 should be appended to the E/M code to indicate the E/M service was a significantly separate service beyond the usual pre- and post-operative care associated with the procedure or service performed.
• If upon review, medical records do not meet these requirements, payment may be denied.
• Modifier 25 should not be used when the sole purpose of the encounter is for the procedure (adjustment of gastric band), and there is no documented medical necessity for a separate E/M service. The decision to perform a minor procedure is included in the payment for the procedure and should not be reported as a separate E/M service.
• If fluoroscopy (76000) is performed in conjunction with the gastric band bill, it is not separately payable. CPT 76000 (Fluoroscopy up to 1 hour physician or other qualified health care professional time) is a “separate procedure” code. This means when performed with other related procedures during the same session, it is not reimbursable.
• 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.

Facility Routine Supplies and Services

The following clarification has been added to Payment Policy POL-PP-111 for Facility Routine Supplies and Services:

• Ventilator management is included in facility charges as it is considered an integral part of the overall care provided to a patient requiring mechanical ventilation, meaning the cost of managing the ventilator, including monitoring and adjusting settings, is factored into the general hospital stay charge rather than being billed as a separate service.
• For more details regarding this payment policy, visit the log-in page at Providers.BlueKC.com and click on Go to Payment Policies.

Ventilator Dependence Education

ICD-10 Code Z99.11 – Dependence on respirator [ventilator] status – requires specific documentation to support the use of this code. Documentation from the provider needs to state the patient is ventilator dependent. This direction comes from the Benefit Year 2023 HHS RADV Protocols and provides these examples:

• “Discharge summary states: A 77-year-old woman was intubated upon arrival for acute respiratory failure resulting from ARDS due to urosepsis. On day 5 of her stay, her oxygen requirements declined such that she is now on an FIO2 of 0.4 with a PEEP of 5 cm H2O. She has been doing poorly and remains vent dependent. She will be transferred to a long-term care facility as per her family's request.
  • i. Ventilator dependence can be abstracted by the medical coder because the documentation states ‘vent dependent’.
• A patient was admitted for elective aortic valve replacement. Before the surgery, the patient was intubated and placed on a ventilator and cardiopulmonary bypass. The patient went into postoperative respiratory failure and remained on the vent for 3 days. The patient was extubated on day 4 with the ability to breathe on their own with no further complications. On day 10, the patient was stable enough for discharge to home with Outpatient Cardiac scheduled.
  • i. Ventilator dependence cannot be abstracted by the medical coder because the documentation does not state the patient was ‘dependent on the ventilator’ or ‘ventilator dependent’.

*NOTE – it has been identified that some EMR systems are not accurately mapping diagnosis descriptions to the appropriate ICD-10-CM code. Ex. CPAP dependence should not be linked to Z99.11.

Codes Inclusive to Imaging Services

Blue KC created Payment Policy POL-PP-254 Codes Inclusive to Imaging Services as a companion to Payment Policy POL-PP-111 Facility Routine Supplies and Services (effective date 9/1/2018) to clarify and list those codes inclusive to imaging services submitted by a facility.

• This policy applies to facility inpatient and outpatient claims.
• Blue KC considers any service or supply that is integral to the provision of a specific service, not separately reimbursable from that service, including:
  • Contrast agents billed in conjunction with an MRI.
  • Radiopharmaceuticals billed in conjunction with a PET scan.
  • Materials billed with a CT or other radiographic study not mentioned above.
  • Non-Ionic Contrasts or low osmolar contrast material.
  • High osmolar contrast material.
  • Isotopes for therapeutic purposes.
• HCPCS Code list is provided.
• 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.

Fracture Care

The following clarification was added to Payment Policy POL-PP-244 Fracture Care on replacement of cast, splint or strapping:

• All services that appear in Musculoskeletal System section (20100–29999) include the application and removal of the first cast, splint or traction device when performed. Therefore, when a physician or other qualified healthcare professional performs a restorative procedure, such as fracture reduction or stabilization, reimbursement for the initial cast, splint or strapping application and/or removal is considered to be included in the payment for the restorative procedure when performed by the same entity.
• Blue KC will not separately reimburse for the cast, splint or strapping application or removal during the global period (major procedures 90 days, this is included as part of the global package).
• Subsequent replacement of cast, splint or strapping during the global period is not separately reimbursable. Cast replacement after the global period has ended may be separately reimbursable when reasonable and necessary. Examples are:
  • the cast becomes damaged,
  • is significantly loose due to swelling reduction,
  • is no longer providing adequate immobilization, or
  • is causing skin irritation.
• For more details regarding this payment policy, visit the log-in page at Providers.BlueKC.com and click on Go to Payment Policies.

Reminder: Carelon Dispute Process

Carelon, an authorized representative of Blue KC, conducts data mining post payment reviews. The impacted facility or provider, based on whether the findings were on a professional claim or facility claim, receives a findings letter identifying a potential overpayment. Once a letter outlining the overpayment is received, the provider/facility has 30 days to file a dispute with Carelon. The findings letter gives two ways to contact Carelon that are included below. The dispute must be initiated with Carelon.

• Carelon Payment Integrity
  PO BOX 17130
  Denver, CO 80217-0130
• CarelonCADdisputes@Carelon.com

If you receive a findings letter and do not wish to dispute, there is no action required. The claim will be adjusted 30 days from date of the findings letter.

A post-pay audit is the final processing of the claim, and no corrected claim will be received after an adjustment is made per the Post-Pay payment policy. If you have any questions or concerns, please contact your Blue KC Account Executive.

Back to Top

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 Policies
Effective date – 4/1/2025	ID: 7.01.156 Title: Radiofrequency Volumetric Tissue Reduction for Nasal Obstruction
Effective date – 4/1/2025	ID: MCG Guideline: BKC-S-5000 Title: Gastric Restrictive Procedures and Management (Bariatric)
Effective date – 4/1/2025	ID: MCG Guideline: BKC-A-0244 Title: Bronchoscopy, Diagnostic and Interventional

Back to Top

Pharmacy Policy Updates

Pharmacy Policy with Changes

Here is a Blue KC pharmacy policy with changes for a drug that will require prior authorization effective April 1, 2025:

Pharmacy Policy with Changes
Policy Number	Policy Name	Summary
5.01.15	Infliximab and Biosimilars	Added medically necessary criteria for refractory sarcoidosis.

Back to Top

Prior Authorization Updates

Code Updates

The codes below will be added to our prior authorization list, effective May 1, 2025.

Code	Description	Effective date	Line of Business
15823	Surgery to remove excess skin and fatty tissue from the upper or lower eyelid. The procedure is sometimes done for cosmetic reasons.	5/1/2025	ACA and Commercial
43633	Surgery to remove a section of the stomach. The procedure involves creation of a new connection to the intestines.	5/1/2025	Commercial

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 or call the Blue KC Provider Hotline at 816-395-3929 to learn more about this faster prior authorization process and give feedback.

Back to Top

Provider Education

Blue KC Member ID Card Changes

Beginning April 1, 2025, the suitcase logo will no longer appear on Blue KC member ID cards, per new branding guidelines from the Blue Cross Blue Shield Association.

• The product indicator of PPO, HMO and EPO will appear in the same place as where the suitcase was located.
• All ID cards are impacted by this change, including Commercial, Small Group ACA and JAA. However, this will not impact ACA QHP for Individual/Family ID cards, which do not display a product with the suitcase logo image.
• While this change will start appearing on cards on April 1, 2025, it should take about a year for updated cards to be issued for all members as cards are reissued during ordinary business (i.e., at renewal or when other changes are made to the card).

An example of the PPO suitcase change is below:

Current Card:

Updated Card: (Change outlined in red)

• BlueCard access will remain the same for members.
• In addition to this change, the in-network and out-of-network limits for deductibles and out of pocket information will be added to the right side of the card above the QR code.

Enhanced EFT and ERA/835 for Provider Reimbursement

Want a fast and secure payment method for your claim reimbursement? Looking for a way to protect PHI and reduce your administrative costs? Sign up for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA/835)!

We encourage you to shift from paper checks and remittance advice and sign up for EFT and ERA/835, so you can take advantage of benefits like the following:

• Speed – Get paid notably faster when you sign up for EFT.
• Efficiency – Many software suites offer automatic posting of data from an ERA/835.
• Savings – Reduce administrative costs associated with paper-based payment and remittance advice.
• Security and Compliance – Better protect PHI data and avoid possible loss of documents or checks.

Sign up for EFT by submitting our Electronic Funds Transfer Authorization Agreement form online here or by going to Providers.BlueKC.com. Log in and click on Forms under Quick Links. The form is in the EFT/ERA Enrollment Forms section. Additionally in that section, you will also find our helpful Frequently Asked Questions (FAQ) document to answer general questions about EFT or ERA/835.

To sign up for ERA/835, please complete the following form on the website of our clearinghouse, Administrative Services of Kansas (ASK): https://www.ask-edi.com/forms/era-enrollment-bcbskc. If you have any questions about this form, the ASK EDI Help Desk is available to assist. To reach them, call 1-800-472-6481 or email ASK at askedi@ask-edi.com.

Collecting Accurate Blue KC Member Information During Patient Visit

Blue KC wants to inform providers that we are experiencing an increase in member feedback regarding the mismatching of member policy IDs at hospitals and provider offices. As a result, claims are being improperly submitted under the wrong individual. Blue KC is providing the information below to help resolve the issue.

Please make sure you are verifying all patient information, including, but not limited to:

Full member name (including middle name)

DOB

Address

Valid ID

Policy number

We encourage providers to collect the member’s physical license and Blue KC member ID card during every visit and to have scanned copies of each on file. Additionally, please make sure to verify maiden/married names and insurance carrier before registering the patient and subsequently submitting to Blue KC.

Provider Outreach Calls

Blue KC is seeing an increase in inquiries and concerns from providers regarding calls from a toll-free number representing Blue KC. We want to make sure you know that Blue KC partners with a healthcare business process management company to make quarterly outbound calls to provider groups and hospitals to verify basic information for helping us maintain an accurate directory.

When calling you, employees from our partner represent themselves as calling from Blue KC, but many times they are mistaken for scam callers. The return phone number is 888-204-5672, which is the number appearing on incoming calls.

If you are wondering whether these are legitimate calls, please be assured that calls from this phone number are being made on behalf of Blue KC. We appreciate you answering so your data can be verified to avoid being suspended from our directory.

New Provider Phone Numbers for Postal Service Health Benefits Program

Blue KC administers the Federal Employee Program (FEP), which provides healthcare benefits coverage for federal employees and retirees. The Postal Service Health Benefits (PSHB) Program is a new separate program that became effective January 1, 2025, within the Federal Employees Health Benefits (FEHB) Program. PSHB provides health benefits plans to eligible Postal Service employees, Postal Service annuitants and their eligible family members.

Blue KC created these dedicated phone numbers for PSHB member inquiries:	Postal Service Health Benefits (PSHB) Program (816) 395-2118 (833) 467-2140
Providers will continue to call the following phone numbers for all other FEHB member inquiries:	Federal Employee Health Benefits (FEHB) Program (816) 395-3678 (800) 892-6048

Member Experience Survey in March

This is one survey you want your patients to take! Starting March 2025, a random sample of members receive a survey regarding their experience with Blue KC and their healthcare providers.

• The survey for our Commercial line of business is known as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey
• The survey for our Small Group ACA and ACA QHP for Individual/Family is known as the Qualified Health Plan (QHP) Enrollee Experience Survey (EES).

It is important to educate your patients, so they know these surveys are not spam.

Member experience surveys are administered between March and June by mail and/or email with follow-up by telephone for those who do not respond to the initial invitation. Surveys are anonymous, your patients are not being asked for personal information, and the surveys are coming from either the Centers for Medicare and Medicaid Services (CMS), Press Ganey or Blue KC. Please encourage your patients to fill out the survey. The CAHPS survey is a scorecard for both Blue KC and you as a provider. A 10 out of 10 patient experience is our goal, and positive member survey scores correlate to:

Patient loyalty to providers and the health plan

Patient engagement with providers and adherence to their medical plan

Better clinical outcomes

In 2025, the CAHPS survey will continue to have a big impact on how we measure the experiences of our members. We encourage you to talk to your patients about the member experience survey during their annual visit.

Blue KC Headquarters to Move in Spring 2025

Blue KC will be relocating our headquarters in Spring 2025. We want to make you aware of the move, so you have ample time to update your records.

• Old Address: 2301 Main Street, Kansas City, MO 64108
• New Address: 1400 Baltimore Avenue, Kansas City, MO 64105-1903
• Effective Date: April 1, 2025

Please make note of our new address and share it internally with anyone who may have formal mailing correspondence with Blue KC. The move will have no impact on our PO Box address, as it will remain the same.

April Lunch-n-Learn

Blue KC is offering a virtual Lunch-n-Learn session titled, “Integrating Cancer Care into Primary Care: Enhancing, Prevention, Early Detection, and More”. This virtual event will take place on Wednesday, April 2, 2025, from 12:00 – 12:50 p.m. CT.

Presenter: Anne Gaglioti, MD, MS, FAAFP, Vice President, Implementation Science, American Cancer Society

Description: This presentation will review current epidemiological trends in cancer, evaluate the role of primary care in enhancing cancer outcomes and share resources from the American Cancer Society that can enhance cancer care in primary care settings.

If interested in joining us at the April Lunch-n-Learn, click on this link to register in advance for this meeting: https://BlueKC.zoom.us/meeting/register/03K2PF26QricPpQdAlB7AA

After registering, you will receive a confirmation email containing information about joining the meeting.

April Free Documentation & Coding Webinar

It’s time to register for a free documentation and coding education monthly webinar hosted by our partner, Veradigm. Each one-hour webinar is approved for one AAPC CEU when you achieve a 70% or higher on the post-test. The April webinar is:

April 22 and 24 7:30 a.m. CT and 11:30 a.m. CT

-

Setting the Stage for Coding and Documentation for Chronic Kidney Disease

-

Deep dive with us into the proper staging, documentation and coding for CKD and associated complications.

To register, click here.

Back to Top

Health Equity

Blue KC Hosts Implicit Bias Training for Healthcare Professionals at Union Station

Earlier this month, Blue KC was proud to host two accredited Implicit Bias Training sessions at Union Station in Kansas City, MO. Dr. Sharla Smith, PhD, MPH presented information to more than 100 healthcare professionals to help create more equitable outcomes for the communities they serve. In addition, the Racial Equity Collaborative lead scripted health scenarios that enabled participants to practice complex conversations and interrupt identified bias recognized by audience members.

Back to Top

Community Investment

Lee’s Summit Teenager and “Keeper for a Cure” Founder Named Blue KC Sporting Samaritan

When Brady Krysiewicz (Chris-a-witz) moved to Kansas City in 2022 to join the Sporting Kansas City Academy, he not only brought his soccer skills but also his ability to help people with cancer through his non-profit “Keeper for a Cure,” which he founded when he was only nine years old. The 15-year-old freshman at Lee’s Summit North High School was recognized for his charitable efforts at the place where he dreams of competing someday.

Before Sporting KC hosted Minnesota on March 15 at Children’s Mercy Park, Krysiewicz was honored in a pre-match ceremony as a Blue KC Sporting Samaritan, which is an initiative that highlights local students and teachers who make Kansas City a better place to live, work and play. Former Sporting KC captain and U.S. Men’s National Team defender Matt Besler teamed up with Blue KC to recognize Krysiewicz as the Blue KC Sporting Samaritan for the month of March.

The partnership between Blue KC and Sporting KC will highlight other noteworthy students and teachers during the season, recognizing their contributions to our community. Blue KC Sporting Samaritans are nominated online at BlueKC.com/NominateSportingSamaritans and recognized on the field at Children’s Mercy Park during pregame festivities at Sporting KC home matches as part of a VIP experience that includes a customized jersey and four tickets to the match.

Through “Keeper for a Cure”, Krysiewicz has managed to raise more than $15,000 for various nonprofits. Most recently, Krysiewicz successfully raised more than $3,000 for Gilda’s Club Kansas City, whose mission is to uplift and strengthen people impacted by cancer by providing support. Motivated by family members who have battled breast cancer, his efforts primarily focus on raising funds for cancer nonprofits. Known as the most vocal supporters of Sporting Kansas City, the Kansas City Cauldron has supported Krysiewicz to further amplify his impact in helping multiple cancer organizations. For more information on Krysiewicz’s inspiring work with “Keeper for a Cure,” visit www.keeperforacure.com.

Back to Top

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.

Back to Top

Contact Us

Your comments are welcome and can be sent to BlueSpeak@BlueKC.com. We would love to hear from you!

Please join the BlueSpeak email distribution list by signing into the Provider Portal and then selecting “Register for BlueSpeak eNewsletter” under “Provider Service Quick Links” on the home page.

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.

Back to Top