Forms
- ID Card Order Form
- Authorization for Release of Protected Health Information (HIPAA form) *
(Form 29-456)- Autorización para divulgar la Información médica protegida *
(Formulario 29-456)
- Autorización para divulgar la Información médica protegida *
- State of Kansas Employee Claim Form *
(Form 34-4)- Formulario-de-reclamo *
(Formulario 34-4es)
- Formulario-de-reclamo *
- Blue Cross Blue Shield Global Core Claim Form (offsite link)
- Claim Appeal Form *
(Form 34-730WEB)- Sus derechos de apelación de reclamaciones y formulario de apelación *
(Formulario 34-730WEBes)
- Sus derechos de apelación de reclamaciones y formulario de apelación *
- Claim Appeal Representative Authorization Form *
(Form 29-58)
* These fillable forms were created with Adobe Acrobat. Visit the Adobe website to download the latest version of Acrobat Reader. Version 9.0 or higher is required.