Blue KC

Blue KC - Submit a Claim

If you’ve paid out-of-pocket for care received from an out-of-network provider, you can request reimbursement from Blue KC for those expenses. If approved, reimbursement will be mailed to the address that is on file for your plan.

We aim to accurately process your claim in 30 business days. If we need more information, we will attempt to reach you by phone and email. If you have questions, please contact Customer Service.

All fields on this page are required unless noted as optional.

Where did you receive care?

Select one of the following options.

Instructions for Medical Equipment or Lab Work



Patient Information – Who received care?

All fields in this section are required.

  • Medicare Advantage: Enter 00 in suffix field.

  • Use MM/DD/YYYY to format the birthday.
    • Self Spouse Child Life Partner Employee Other
    • Male
    • Female
    • Prefer not to answer

Policyholder Information

All fields in this section are required.

Healthcare Provider Information (Rendering Provider)

All fields in this section are required unless noted as optional.

  • The name of the individual who rendered or delivered care.
  • This is required. If you need help, ask your healthcare provider for their Tax ID.
  • To receive expedited processing, we encourage you to ask your healthcare provider for their NPI number.
  • Optional
  • Medical Equipment or Lab Work – Learn how to provide the correct address for medical equipment or lab work claims.

Attach Itemized Receipt(s) from Your Healthcare Provider

Ask your provider for an itemized receipt, which provides proof of the care received. This document(s) is required and must include the following: provider name, the provider’s Tax ID, date(s) of service, the amount charged, a diagnosis code, a procedure code and the place of service. For your request to be honored, work with your provider to make sure all required information is included.

Attach document(s) from your provider:
PDFs or images are allowed. Press and hold the CTRL key to select and upload multiple files.

Claim Details

All fields in this section are required unless noted as optional.

  • Ambulance
    Home Health Visit
    Hospital Visit (inpatient)
    Hospital Visit (outpatient)
    Medical Equipment
    Office Visit
    Telehealth or Video Call
    Urgent Care

Additional Questions

Is the illness or injury connected to the patient's employment?

  • Yes
  • No
  • Use MM/DD/YYY to format the date.

Does the patient have other group coverage?

  • Yes
  • No

Provide Your Email Address

An email address is required. We will email a copy to your inbox for your personal records.

If you experience issues submitting this form, please print and fax it to 816-278-1946.

Or mail to:

Blue Cross and Blue Shield of Kansas City
PO Box 419169
Kansas City, MO 64141-6169

Important: By continuing below, you agree that all information provided is accurate to the best of your knowledge. You understand that falsifying or misrepresenting essential information is a serious crime which could lead to fines or imprisonment.