Case Management Support for Providers
Blue Cross and Blue Shield of Kansas (BCBSKS) case management services are designed to support providers by helping members navigate complex healthcare needs, improve care coordination and reduce avoidable gaps in care. Case management enhances the provider’s treatment plan – it does not replace clinical decision-making or the patient-provider relationship.
How Case Management Supports Your Practice
- Helps members understand and follow the provider’s treatment plan, including medications, follow-up appointments and self-management goals
- Coordinates services across care settings, including home health, hospice, behavioral health, specialty care and community-based resources
- Identifies potential gaps in care, such as preventive screenings, follow-up needs, medication access concerns and barriers to care
- Supports discharge planning and post-discharge outreach for members at risk for readmission
- Helps members access contracting providers and appropriate benefit options when available
- Connects eligible members with disease management, wellness and behavioral health resources
When to Consider a Case Management Referral
Providers, office staff, hospitals, members, caregivers, employers and internal BCBSKS teams may refer members for case management. Consider a referral when a member may benefit from additional support beyond the clinical visit.
- Complex or catastrophic illness or injury
- Multiple chronic conditions or frequent changes in treatment
- High-risk pregnancy or NICU needs
- Recent hospitalization, high risk for readmission or difficulty understanding discharge instructions
- Complex wound care, transplant, ventilator dependency, specialty medication or infusion needs
- Progressive neurological conditions such as ALS, MS or muscular dystrophy
- Palliative care, end-of-life care or caregiver support needs
- Behavioral health needs that may affect medical care or follow-through
- Difficulty accessing care, medications, equipment, transportation or community resources
- Care coordination needs across multiple providers, facilities or services
What Providers Can Expect
- A case manager will review the member’s needs, available benefits, medical history and barriers to care.
- The case manager may contact the member or caregiver to assess needs, establish goals and provide education and support.
- When appropriate, the case manager may coordinate with the provider’s office to clarify the treatment plan, support follow-up and help address barriers.
- Case management recommendations are intended to complement the provider’s plan of care and support safe, timely, cost-effective care.
- Participation is voluntary for the member and provided at no additional cost.
Information Helpful for a Referral
To help case management respond efficiently, include as much relevant information as possible with the referral.
- Member name, date of birth and member ID number
- Primary diagnosis and reason for referral
- Current treatment plan and key providers involved
- Recent hospitalization, discharge plan or upcoming procedure details
- Medication, equipment, home health, hospice, behavioral health or community resource needs
- Known barriers such as transportation, affordability, caregiver support, health literacy or difficulty with follow-up
- Best contact information for the member or caregiver
Care Transitions and Discharge Support
Transitions of care are a key time to involve case management. Early discharge planning, timely follow-up, medication review and confirmation of services can help support a safer transition and may reduce preventable readmissions.
Shared Goal
Our shared goal is to support members in receiving the right care, in the right setting, at the right time. By working together, providers and case managers can help members better understand their care plan, overcome barriers and achieve improved health outcomes.
Have a Member Who May Benefit From Extra Support?
A case management referral can help connect the member with education, resources, care coordination and follow-up support while keeping the provider’s treatment plan at the center of care.
Case Management: 800-432-0216, ext. 6628
FEP Case Management: 800-432-0216, ext. 6611
Medicare Advantage Case Management: 800-432-0216, ext. 6673