Plan Details
Member Identification and Verification of Eligibility
Before any services are rendered, Provider must conduct a member verification under each benefit plan. Once verification is in place, Provider shall provide timely accessibility to members.
An individual’s possession of a membership ID card is not a guarantee of eligibility or benefits. Always verify eligibility and benefits in advance of providing (non-urgent or non-emergent) services. Always verify another form of legal photo identification, such as a driver’s license, passport or other government issued ID, to help prevent identity theft.
Member eligibility and benefits can be verified:
- Online at Providers.BlueKC.com
- By calling our Provider Hotline (see Contact Resource Directory
Providers calling customer service must be able to verify their identity as well as the patient’s identity:
- Inquirer’s name
- Inquirer’s telephone number
- Provider Blue KC number or Tax ID number
- Provider name
- Member’s Blue KC ID number or social security number
PPO, HMO and EPO Defined
Participating/Traditional Provider is a Participating Hospital, Participating Physician and any Ancillary Provider that has entered into agreements with Blue Cross Blue Shield of Kansas City (BlueKC), or with another organization that has an agreement with BlueKC to provide Covered Services to Covered Individuals at the negotiated payment rates.
Preferred Provider Organization (PPO)
- Emphasizes Choice
Networks
- Blue Medicare Advantage
- Preferred Care
- Preferred Care Blue
- Blue Access
- Blue Select
- Blue Select Plus
Health Maintenance Organization (HMO)
- Emphasizes Prevention and Predictability
Exclusive Provider Organization (EPO)
- Emphasizes Affordability Networks