Claim Inquiry

Please wait at least 30 days, but no more than 180 from the original submission date before you send an inquiry on claim status.

In order for Blue KC to comply with Missouri Prompt Pay Statuses 376.383 and 376.384 please indicate if you are responding to a request for additional information from Blue KC.

  • Yes
  • No
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* Required Field

Enter Patient Information

  •  
  • We're unable to prepopulate the below information using ID you entered.
  •  
  • Patient Number:*
    Include Alpha Prefix
  • - -
  • Patient First Name: *
  • Patient Middle Initial:
  • Patient Last Name: *
  • Patient Group ID: *
  • Patient Group Name:
  • Date(s) of Service: *
  • Must be valid date.
  • Original Claim Number:
  • Total Charges: *
  • Patient Account Number:

Enter Policyholder Information

  • Policyholder First Name:
  • Policyholder Middle Initial:
  • Policyholder Last Name:

* Required Field

Enter Practitioner Information

Information entered in this section should match what is on the original claim

  • Provider ID OR NPI: *
  • Practitioner's Name: *
  • Practitioner's Address: *
  • Practitioner's City: *
  • Practitioner's State: *
  • Practitioner's Zip: *
  • Practitioner's Phone Number:
  • Practitioner's Fax Number:
  • Practitioner Group or Facility Name:
  • Contact First Name:
  • Contact Last Name:
  • Contact Email Address:
  • Contact Phone Number: *
  • Ext.
    Enter a 10 digit phone number.
  • Contact Fax Number: *
  • Enter a 10 digit phone number.

Today's Date:

Please check the reason(s) for the inquiry:

  • Void/billed in error
  • Corrected Claim: (include attachment)
  • Overpayment
  • Questioning Allowable (please submit Operative/Emergency Room report, Certificate of Medical Necessity, and/or vendor invoice showing the charges billed)
  • Other: (Please provide a full explanation)

Please indicate the supporting documentation you are submitting as part of this inquiry:*

Supporting documentation must clearly identify the patient's name, pollicy holder's ID # and date of service.

  • Corrected Claim
  • Medical Records
  • Other: (Please provide a full explanation)

Please attach supporting documentation:

Choose a file or files to attach (File types accepted: jpg, txt, doc, docx, pdf, xls, xlsx, ppt, pptx, rtf, tiff, and tif)

To upload multiple files, hold down the CTRL key while selecting multiple documents then click open.







Please attach supporting documentation: *

Choose a file or files to attach * (File types accepted: jpg, txt, doc, docx, pdf, xls, xlsx, ppt, pptx, rtf, tiff, and tif)

To upload multiple files, hold down the CTRL key while selecting multiple documents then click open.







  • Checking this box will send a copy of your form to the email address provided.

If you experience issues submitting this form, please print and fax it to (816) 817-8211.

If you have questions, contact Blue KC at (816) 395-3989.

Cancel

Member Prefix

Your prefix is on the front of your Member ID card. See the sample ID card above. If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842.

IMPORTANT: If you are an FEP Member, enter "NA" into the Prefix field.

ID Number

Your member ID is a unique number that identifies your plan. It is on the front of your Member ID card. See the sample ID card above. If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842.

Suffix

Your Suffix is a two digit number located on your Member ID card. See the sample ID card above. If you do not have your member ID card, contact the Customer Service department by clicking Contact Us, or calling 816-395-3558 or 888-989-8842.

For Blue Card members, suffix is not required.

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