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Institutional Provider Tools and Resources

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Manuals

  • Institutional Provider Manual (offsite link)
    • See the Institutional Provider Manual for information on Revenue Codes and Items Not Separately Billable
  • Electronic Inpatient Precertification System Manual
  • Establishing Secure Access for Providers to Member Information
  • Quality-Based Reimbursement Program (QBRP) Portal Manual
  • Claims Pricing Manual

Resources

  • 2024 State of Kansas Comprehensive Site of Care Specialty Drug Program Prescription Drug List (Excel workbook)
  • 2023 New Directions Medical Necessity Criteria (offsite link)
  • Apixio Provider Portal and Ensuring Payment Integrity
  • Preventive Services Quick Reference Guide
  • Remittance Advice - HIPAA Codes (offsite link)
  • Diagnosis Codes Exempt from POA Reporting (offsite link)
  • 2023 State of Kansas Pharmacy Benefit List
  • Exchange, BlueCard and Kansas Provider Networks
  • Policies and Procedures (offsite link)
  • Outpatient Medical Drug Exclusion List
  • No Surprises Act Fact Sheet
  • HL7 v2 Specification (Excel document - Updated July 2022)
  • Updating Provider Profile Information
  • Provider Message Portal - How to Sign up

Credentialing Criteria

  • Credentialing Criteria - Facilities
  • Practitioner and Facility Credentialing and Re-credentialing
  • Credentialing Program Plan Description

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Blue Cross and Blue Shield of Kansas serves all counties in Kansas except Johnson and Wyandotte.
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