Forms

Currently the Blue KC Provider Portal is undergoing maintenance. Electronic form submissions will be unavailable from 9/14/2023 at 5:00 p.m. to 9/18/2023 at 8:00 a.m. Thank you for your patience and understanding.

Ensure you are using the latest web browser version in order to submit electronic forms. The online form submission is not available to iOS devices (an operating system used for mobile devices manufactured by Apple). If you are using one of these devices please use the PDF to complete your form.

Appeals

• Member Complaint/Grievance Form
• Member Authorization Form
• Out-of-Area Members: Medical Necessity Appeals Form

Claim Forms

• Claims Inquiry Form (PDF)
• FEP Member Reimbursement Claim Form
• Itemized Bill Submission Form
• Medical/Dental Claim Form (PDF)
• Pharmacy Claim Form (PDF)
• BlueCard Worldwide International Claim Form

EFT/ERA Enrollment Forms