Claims Payment Policies and Practices
Claim Filing: If the member receives covered services from a contracting provider, a claim will be filed on their behalf by the provider.
If the provider is non-contracting and does not agree to file the claim or the member has a prescription benefit in which filing a claim is required for reimbursement, the member may access the Forms section to obtain the correct claim form. This form may also be obtained by contacting our Customer Service Center at 1-(800)432-3990.
For prescription drug claims: File one claim per patient and attach an itemized bill from the pharmacy with the pharmacist’s signature or the pharmacy receipts. Do not send cash register receipts. The proof of service must include patient’s name, prescription name, and prescription Rx number, National Drug Code, quantity, number of days supply, service date, cost for each prescription plus the complete name and address of the pharmacy, and the pharmacy tax ID number.
For all other services: File one claim per patient and attach an itemized bill from the service provider. The itemization must include the patient’s name, the service provided, service date, cost for each service, diagnosis, and the provider’s name and tax ID number. Please complete a separate claim form in full for each hospital and/or doctor bill being submitted.
Prompt filing of claims: Notice of your claim must reach Blue Cross and Blue Shield of Kansas within one (1) year and ninety (90) days from the date services were received.
**NOTE: Claims for members that are insured by the Federal Employee Program must be received within 15 months of the date of service or by December 31 of the year following the year in which services were received.
File Claims to:
Blue Cross and Blue Shield of Kansas
1133 SW Topeka Boulevard
Topeka, KS 66629-0001
Payment for Services: Payment for covered services received from a contracting provider is made to the provider. Generally, we issue one check per week to the provider.
Payment for services received from non-contracting providers are made to the member. We also make payment to the member for services provided by a pharmacy, in which the member has to file their claim. We issue checks to the member the evening after the claim has been finalized.
An Explanation of Benefits (EOB) is issued to the member for each claim processed by BCBSKS. In the event that the provider is paid, an EOB will be sent to you indicating this information.
BCBSKS Claims Processing Goals
- Timeliness: Process 99% of claims received within 30 calendar days of the date it was received by our office.
- Claim Accuracy: Process 98% of all claims received accurately.
- Claim Financial Accuracy: Process 99% of all claim dollars accurately.
- Electronic Claims: When filing electronically, providers are required to submit claims to BCBSKS in a HIPAA standard format.
Member Claim Appeal Rights: The member may request the review of an adverse decision on a Pre or Post service claim, in which they are financially responsible. The Claim Appeal Form must be completed with the appropriate Explanation of Benefit (EOB) attached. The member may access the member Forms to obtain the correct Claim Appeal form. This form can also be obtained by contacting our Customer Service Center at 1-(800)432-3990.
Provider Claim Appeal Rights: Contracting providers may appeal certain pre and post-service claim denials. All appeals must be submitted in writing with all pertinent medical records to BCBSKS Customer Service. Additional information regarding appeals can be found in Policy Memo No. 1, Policies and Procedures, which can be found under the Provider Publications section.
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