One ( ) - State ZIP Code County State ZIP Code County State ZIP Code County ID# Supplier Name Section 1 Printed or Typed Address Street City Telephone ( ) - NPI# Physician Name Printed or Typed Address Street City Telephone ( ) PT DOB - / / ID# SEX (M/F); HT (IN.); WT. (LBS) SECTION 2: MEDICAL NECESSITY INFORMATION (Physician if this section is blank please complete) Estimated length of need (# of months): 1 through 99 (99 lifetime).
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How to fill out the KS BlueCross BlueShield 15-509 online
Completing the KS BlueCross BlueShield 15-509 form is essential for documenting the medical necessity for a manual wheelchair. This guide will provide you with clear and detailed instructions to assist you in filling out the form accurately and efficiently.
Follow the steps to complete the form successfully.
- Click ‘Get Form’ button to obtain the form and open it in an editor for completion.
- In Section 1, enter the certification date. Fill in the patient’s name, address, city, state, zip code, and telephone number. Ensure that the ID number is included along with the supplier name and their details, similar to how you filled the patient's information.
- Move to Section 2 to provide medical necessity information. If this section is incomplete, ensure the physician fills it out. Include the estimated length of need and relevant diagnosis codes.
- Detail any additional medical conditions that pertain to the patient's use of a wheelchair, such as musculoskeletal conditions or need for specific arm height.
- In Section 3, itemize any items and charges related to the wheelchair. Attach an additional sheet if necessary for further details about specific needs and charges.
- After completing all sections, save any changes made to the form. You can also choose to download, print, or share the completed document based on your needs.
Act now and complete your KS BlueCross BlueShield 15-509 form online to ensure timely processing.
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What is the phone number for BCBS Kansas City Medicare Advantage provider?
Customer Service Toll Free Number 1-888-989-8842 Phone Number 816-395-3558 TDDY 816-842-5607 Available Monday - Friday 8:00 a.m. to 8:00 p.m. Central Time.
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Structure of two carriers Anthem Blue Cross is a publicly-traded, for-profit company. Blue Shield of California is a non-profit.
Is BCBS of Kansas the same as BCBS of Kansas City?
Blue Cross and Blue Shield of Kansas (BCBSKS) and Blue Cross and Blue Shield of Kansas City (Blue KC) are separate companies. Each operates independently and makes its own decisions regarding the markets they serve.
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BCBSKS' right to recoup monies paid when another insurer has legal responsibility for payment of expenses. The substitution of one for another as creditor so that the new creditor succeeds to the former's rights or obligations.
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