You will be directed immediately to the Member I-D input page, and you can select the View History button. Although a service may be medically necessary, it may be excluded under a members benefit plan. This webpage provides instructions for developers to learn how to connect to and consume the Patient Access API, Provider Directory API and Payer to Payer API. Check the initial credentialing status for new providers. The Medical Policies contained herein are for informational purposes. Check the initial credentialing status for new providers. Once you have completed your development within the test environment you may shift to using the Production URLs. Provide the information of your billing group and the Blue KC provider I-D of the providers you are contracted with. You will be asked about privacy policies and which access is desired for your application, An independent licensee of the Blue Cross and Blue Shield Association. We highly recommend PKCE for any mobile app usage and PKCE can be integrated into any flow. others. Blue KC Interoperability Developer Portal. Need help? If you have questions, please email Blue KC. If you're a Blue KC member or customer, please review our information for If the member/patient has authentication issues, please direct the member to Then select, Lookup. Below are examples on how to search all practitioners, a specific practitioner by reference ID, and a specific practitioner by name. Keep in mind you may be routed to other partner sites for different types of prior authorization requests, such as eviCore or Avalon. broker_services@bluekc.com. authorization step must pass the generated token to the app on the mobile device. token with the refresh token). An independent licensee of the Blue Cross and Blue Shield Association document.write(new Date().getFullYear()) Blue Cross and Blue Shield of Kansas City. For example: Kerry's patient ID is 90003160541. So, just choose the member you want to get to the code selection screen. for such flows. member education on Interoperability. 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 you have already signed-up for myBCBSRI, please login below. 2020 Blue Cross and Blue Shield of Kansas City. If you don't know a practitioner's name you can use the Practitioner endpoint with no added search parameter, then locate the desired practitioner. For those all-important details about your health plan, all you have to do is ask. Need help? To use Avalon's Prior Authorization system, you require a user account to Avalon's Provider Portal. Blue KC - Provider Portal Providers with Internet access can quickly find answers to questions about members, providers, and benefit plans by visiting Blue KC's provider portal at Providers.BlueKC.com. Our Terms of Service deal with concerns about providing minimal 3. Credentialing Status. Log In Create an Account Need help registering? Finally, you will be directed to the proper Blue KC vendor Portal to complete entry of electronic prior authorization. An example search for Garry Martin is listed as Martin, Garry in the data so the search is "Martin Garry", with no comma included. Select Submit or Review a prior authorization. OIDC (OpenID Connect, OAuth 2.0) authorization flow. Register now or learn more. When you partner with Blue KC, youre aligned with one of the most timeless and trusted names in the industry. Obtain forms for: Pre-authorization Pharmacy, Pre-service, Utilization Management, and; Little Stars Physician Referral forms; Forms Go to Payment Policies New Provider Network Interest Form In some cases, an Authorization Type dropdown will display. The agent portal is your one-stop resource for tools and information related to your Blue KC accounts. The member will also need to set up 2 factor authentication using either the Microsoft or 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 Within your app this allows you to manage only one JWT, but pull data for multiple people. Check the initial credentialing status for new providers. Explore guidance and resources Pay a bill For members with an Individual/Family plan only (not through an employer), easily and quickly pay your Blue KC bill. Our powerful digital tool for providers can be accessed 24/7 with a click of a button! Find all providers and their personally related resources/services/etc Below we have provided sample URLs for calling our Provider Directory API. With tools and actionable data to support more coordinated, targeted care, you can reduce unnecessary medical bills and get healthy faster. Find a doctor, hospital or other healthcare provider. Credentialing Status Obtain forms for: Pre-authorization Pharmacy, Pre-service, Utilization Management, and Little Stars Physician Referral forms 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. A plan through their employer A Medicare Advantage plan An individual or family plan (Affordable Care Act) A short-term individual or family plan (E.g.,Member Eligibility Lookup ; Authorization Entry ; Claims Lookup) I am a Medical Billing Group working on behalf of one or more Blue KC Providers. PROVIDER LOGIN Members Have It Made with Blue Blue KC members can access doctors, hospitals and pharmacies through a variety of networks. If Blue KC has not yet received your CAA premium survey information for 2020/2021, please complete at the following link:CAA Premium Survey. Open the dropdown, and you can search through any procedure, code or drug name and make your selection. These Medical Policies describe when medical services are considered medically necessary, not medically necessary or investigational. Sandbox is designed to be as functionally Blue KC is proud to be the largest provider of health insurance plans in a 32-county area serving greater Kansas City and northwest Missouri. See your most recent claims. Your patients want the confidence of the Cross and security of the Shield. 4. In the Recent News Updates section, youll find: To take advantage of an easier prior authorization experience, make sure you have a Blue KC Provider Portal account. You can use the Practitioner endpoint with a given practitioner name at the end of the URI. Check the box if you are an office administrator, hit register and you are done! 5. info, Learn about NICU level of care authorizations and case management, October 2023 Medical and Pharmacy Policy updates now available, Third quarter 2023 hospital outpatient drug fee schedule posted. Provider Login Not Registered for the Provider Portal? Just call the endpoint and you're on your way! The search for all practitioners is quite easy. To page over, you can use a URI which includes page numbering: Before using our production URLs, please utilize the UAT URLs provided in the hyperlinks. in loss of access to Blue KC Patient Access APIs. All rights reserved. irrespective of the credentials passed as long as authentication succeeds. OAuth 2.0 authorization code flow in Azure Active Directory B2C, Azure AD B2C OAuth 2.0 token endpoint (v2), https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropAppDeveloperAuthorizationFlow/oauth2/v2.0/token, Azure AD B2C OAuth 2.0 authorization endpoint (v2), https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropAppDeveloperAuthorizationFlow/oauth2/v2.0/authorize, Azure AD B2C OAuth 2.0 logout endpoint (v2), https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropAppDeveloperAuthorizationFlow/oauth2/v2.0/logout, Azure AD B2C OpenID Connect metadata document, https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropAppDeveloperAuthorizationFlow/v2.0/.well-known/openid-configuration, https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropAppDeveloperAuthorizationFlow/Samlp/metadata, Azure AD OAuth 2.0 authorization endpoint (v2), https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropMemberAuthorizationFlow/oauth2/v2.0/token, https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropMemberAuthorizationFlow/oauth2/v2.0/authorize, https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropMemberAuthorizationFlow/oauth2/v2.0/logout, https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropMemberAuthorizationFlow/v2.0/.well-known/openid-configuration, https://bluekcprod.b2clogin.com/bluekcprod.onmicrosoft.com/B2C_1A_InteropMemberAuthorizationFlow/Samlp/metadata. contact our compliance office. Please call the provider before making an appointment to verify that the provider continues to be part of the network. Request the Member Handbook, a list of providers, and other important documents to be mailed to your home. Learn more Use your account to access your digital ID card, view benefits, check claims, and more. PROVIDER DIRECTORY PAYER TO PAYER Search for Practitioner (s) Find all providers and their personally related resources/services/etc. Notice the element "consentedMemberNamesAndBeKeys". Access to the Patient Access API requires a user account. 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. information we needed a way store in the JWT who the patient has authorized for your app. Note: E-P-A is a pre-service review for Out of Area members. The name search parameter is case insensitive but will not accept commas even if they are URL encoded. Once you log-in and arrive on the home page, click on Prior Authorizations, and youre ready go: Enter the Member I-D to submit prior authorizations or view if a prior authorization is required. State and Federal mandates and health plan contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. Once a token (JWT) is issued, its security is the responsibility of your app. All rights reserved. AppID, return URLs and scope. Credentialing Status Using the Practitioner endpoint, you will not need to provide any search parameters. access token must be presented at the API in order to get any data returned. To request an account for your users and to register your app please The new enhancements provide quicker account registration and a much easier prior authorization experience. During the flow a standard authentication step will occur. Plus, they enjoy the highest quality health coverage, and highest level of customer service. To determine how to use PKCE in your app please consult your app devleoper documentation on how to implement PKCE in particular with Azure B2C. A return status of 403 is non-recoverable and indicates a bad search parameter, a resources Register now or learn more. We won't share the information we collect. Forgot Password? 2023 Blue Cross and Blue Shield of Kansas City. If you don't yet have a MyBlueKC account, create an account first. View and share your ID card. This webpage provides instructions for developers to learn how to connect to and consume the Patient Access API, Provider Directory Then, scroll down to the prior authorization section. We can assist in validating your configuration. Not Registered for the Portal? Refresh It is considered extremely sensitive and failure to adequately safeguard tokens may result Per CMS Interoperability rules we can remove vendors and 3rd parties from access to our published APIs if they present a risk fill out this Forgot Password? Blue Benefit Bucks (BBB) Intro Video Blue Benefit Bucks Your Blue Benefit Bucks (BBB) card works like a debit card and comes loaded with the benefits from the plan you choose. If you have questions, please email Blue KC. All rights reserved. tokens are only available with the appropriate OIDC flows and PKCE is strongly encouraged 2020 Blue Cross and Blue Shield of Kansas City. Enter the 16 digit card number and expiration date of your Benefits Mastercard Prepaid Card. Our new-look home page gives one- to two-click access to: A Quick Links section on the home page gives you easy access to: M-L-E, which stands for Member liability estimator and R-T-C-A, the Real Time Claims Adjudicator. If you wish to continue using the Blue KC employer portal, you must contact your companys Organizational Administrator (OA) for registration assistance. PKCE prevents other apps from reading that token from the browser to use the token for Email. To determine how to use Select one of the two categories below to browse prior authorization forms. Please ask us to turn on the feature for you on the Azure B2C side. Both fields are required. Registered Marks of the Blue Cross and Blue Shield Association. Medical policy Medication search BCBS Plan Medical Policy & pre-cert. And thats one healthy place to be. Welcome to MyBlueKCMA Your Personalized member portal with easy access to your ID card, coverage details, and more. We've doubled spending on mental health care. Login to access your plan information If you're enrolled in a Blue KC Medicare plan, there's a member portal available to give you easy online access to the information you need. Speed through the process of submitting insurance claims online and get reimbursed faster. PKCE is designed to deal with a specific attack wherein the the browser used to perform the For any questions or concerns about compliance please A return status of 401 is recoverable and requires re-authentication (or renewing the access and SM Service Marks are the property of their respective owners. Compliance with and agreement to our Terms of Service is required to access and use Interoperability APIs. Your customers want high-quality health insurance at an affordable price. Member Services Behavioral health services for Blue KC members Blue KC is dedicated to thinking differently about coverage and care, enhancing the behavioral health services provided in member health plans. When queries against the API need the patientId parameter you can find the allowable patient To request a new user account, email your lab's name, username(s), email address, office phone number, supervisor's name, and email address to Avalon-PAS-Help@avalonhcs.com. Pursuant to CMS Interoperability requirements we are providing instructions for app developers to access to the Patient Access, To learn more, view the summaries and videos below: An independent licensee of the Blue Cross and Blue Shield Associationdocument.write(new Date().getFullYear()) Blue Cross and Blue Shield of Kansas City. Register Now Username Password How to Use the Provider Portal Forgot Username? services. 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. BlueKC Dental Provider Directory Blue Cross and Blue Shield of Kansas City (Blue KC) has made reasonable efforts to ensure that the list of providers displayed is up to date and accurate. The Medical Policies do not constitute medical advice or medical care. PKCE is designed to deal with a specific . Welcome to Blue KC's Provider Portal. Call us at (866)508-7140. With Blue KC Medicare, we'll help you find a plan that works for your wellness goals now and tomorrow. Blue KC's provider portal gives you 24/7/365 access to: Member information such as the status of a claim, eligibility of a member,