Find Care Contact Blue KC

Itemized Bill Submission

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* Required Field

Enter Claim Information

  • Claim Number:
  •  
  • We're unable to prepopulate the below information using ID you entered.
  •  
  • i
    i
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  • Member ID Number
    (3-digit prefix followed by remaining digits):*
  • - -
  • Patient First Name: *
  • Patient Middle Initial:
  • Patient Last Name: *
  • Date of Birth: *
  • Must be valid date.
  • Admission Date:

* Required Field

Enter Facility Information

  • Provider ID OR NPI: *
  •   
  • Facility Name: *
  • Facility Address: *
  • Facility City: *
  • Facility State: *
  • Facility Zip: *

Enter Contact Information

  • 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.

Please attach the itemized bill: *

Please Note: Maximum attachment size is 5 MB.

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 try again later.

Or, print the form and mail to:

Blue Cross and Blue Shield of Kansas City
Pharmacy Services
P.O. Box 412735
Kansas City, MO 64141-2735

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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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