Welcome to Blue KC’s Provider Portal. Our powerful digital tool for providers can be accessed 24/7 with a 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, view the summaries and videos below:

Enhanced Account Registration

• Click “Register Now” on the log-in page.
• If you click on “I am a Provider”, which is for users who belong to a covered entity or Blue KC contract holders, you will be directed to a basic form. Next, answer the question, “Are you a Blue KC participating provider?” If you answer yes, you type in your Blue KC Provider I-D number.
• Check the box if you are an office administrator, hit register and you are done!
• If you click on “I am a Medical Billing Group”, which is for users who are part of a billing group that is contracted with a Blue KC provider, choose “New Billing Group” if this is the first time your billing group is registering on the Blue KC Provider Portal. Provide the information of your billing group and the Blue KC provider I-D of the providers you are contracted with.
• If you believe your billing group has already registered with Blue KC and you need a user I-D to access the Blue KC Provider Portal, then click “Existing Billing Group”. Input your billing group information. Following the submission of either request, Blue KC will review the provided information and respond back to you with the next steps for completing your account creation.

Enhanced Home Page

• Our new-look home page gives one- to two-click access to:
  • Member Eligibility and Benefits
  • Prior Authorizations
  • Claims Inquiry
  • Remittances
• A Quick Links section on the home page gives you easy access to:
  • Forms
  • Find a Provider
  • M-L-E, which stands for Member liability estimator and R-T-C-A, the Real Time Claims Adjudicator
  • COVID-19 Information
  • E-P-A, which stands for Electronic Provider Access. Note: E-P-A is a pre-service review for Out of Area members.
  • Prescription Drug Monitoring Program
• In the Recent News Updates section, you’ll find:
  • New Policies and Updates
  • Provider Bulletins

Enhanced Prior Authorization

• To take advantage of an easier prior authorization experience, make sure you have a Blue KC Provider Portal account. Once you log-in and arrive on the home page, click on Prior Authorizations, and you’re ready go:
  • Enter the Member I-D to submit prior authorizations or view if a prior authorization is required. You can input the prefix or exclude it.
  • Then select, “Lookup”. We do want to note if you input an F-E-P Member I-D number, and then select “Lookup”, you will be immediately directed to the Guiding Care site. If the I-D is related to more than one member on the plan, you will be directed to all the members on that plan. So, just choose the member you want to get to the code selection screen.
  • Open the dropdown, and you can search through any procedure, code or drug name and make your selection. And you also have the option to do a “type-ahead capability” for things like C-P-T code, the name of the procedure or the name of the drug. The procedure or drug will appear.
• After making your selection, you will be presented with a Disclaimer and a “Submit Prior Authorization” button if a prior authorization is needed for the code, service or drug name you entered. In some cases, an “Authorization Type” dropdown will display. This is based on if the selected code is a Medical Service for Inpatient, Outpatient or a drug on the medical benefit.
• Finally, you will be directed to the proper Blue KC vendor Portal to complete entry of “electronic prior authorization”. Keep in mind you may be routed to other partner sites for different types of prior authorization requests, such as eviCore or Avalon.
• To view an existing electronic prior authorization request, once logged in to the Provider Portal, select Prior Authorizations. You will be directed immediately to the Member I-D input page, and you can select the “View History” button. Then, you will be routed to the Guiding Care Portal for a list of previously entered prior authorizations.
• What happens if you are unable to get a user I-D on the Blue KC Provider Portal? On the log-in page, click the Forms button to get to our Forms page. Then, scroll down to the prior authorization section. You will land on the first step of beginning a prior authorization. Select “Submit or Review a prior authorization”. On that page, you should select the “Review or Submit Prior Authorizations” button to log in and enter a Prior Authorization electronically on the Portal. As a last resort, you can choose a fax, mail or e-form option.