Eligibility and Claim Status Inquiry Guidelines

Blue Cross and Blue Shield of Kansas (BCBSKS) wants to ensure providers receive timely responses to real time eligibility and claim status inquiries under related HIPAA mandated transactions. For timely member access to health care, the following guidelines should be adhered to:

270 – Eligibility and Benefits Requests

• Eligibility and Benefit requests should only be submitted for members with scheduled services based on the applicable service type code.
• Requests should not be submitted for full patient load or all available service types.
• A minimum of 20 seconds should be allowed prior to resubmitting a request.
• Prior to submission, member data should be validated using the member ID card to ensure the request is accurate and to avoid rejections.

276 – Claim Status Requests

• Claim Status requests should not be submitted until a claim has aged a minimum of seven days.
• Prior to submitting a Claim Status request, refer to the claim acknowledgment provided from the corresponding electronic claim submission to confirm acceptance.
• Claim Status requests must be submitted under the appropriate billing provider NPI to receive a response.

If you have any questions, contact your BCBSKS provider relations representative, or call the ASK-EDI help desk at 800-472-6481 or email [email protected].