KingCareSM Health Plan for King County Employees
The KingCare health plan for King County employees is administered by Regence BlueShield under the National Alliance platform effective January 1, 2012.
The KingCare medical product uses the Regence Preferred Provider Plan (PPP) network within the Regence BlueShield service area. Members traveling or residing outside the Regence service area have access to the BlueCard® PPO and the BlueCard Worldwide networks.
Use the My Health Toolkit® provider portal to access a variety of tools and resources including:
- Forms — Helpful forms to view and complete.
- Medical Policies — View the guidelines used to make clinical determinations.
- My Insurance ManagerSM — Use this secure, online tool to verify member eligibility, claims status, other health insurance, authorizations and more. When this tool is accessed, a note is created and attached to the member’s account that indicates:
- Who checked the site (the tax identification [ID] and National Provider Identifier [NPI] of the provider’s office are captured)
- What was checked (e.g., benefits, claims status, eligibility)
- What information they received and the date they received it.
To obtain full access to My Insurance Manager, send an email including the following information:
The provider’s information will be entered and he or she will receive a reply via email with the credentialing identification number.
Note: Contact Provider Education at 1 (803) 264-4730 or via email, if you experience technical issues when registering to use My Insurance Manager.
Claims submission information
Include the member’s identification (ID) number (up to 15 characters in length) the alpha prefix, KRC. See sample member card below.
Mail paper claims to:
P.O. Box 30271
Salt Lake City UT 84130-0271
Submit electronic claims for your KingCare patients with your other Regence BlueShield patients.
Sample member card:
Express Scripts® administers the pharmacy benefits for both retail and mail order prescriptions.
Inpatient admission requirements
The member or his or her provider must obtain pre-authorization for the following services within 48-hours from the beginning of an admission or as soon as reasonably possible, for all inpatient admissions, including:
- Mental health and substance use, including:
- Involuntary commitment to a Washington state mental hospital
Please refer to the pre-service information listed in the in the Important phone numbers box at the top of this page.
Milliman® inpatient admission guidelines apply. Concurrent review will not be performed by Health Integrated for these members.
Radiology Quality Initiative (RQI) requirements do not apply to KingCare members. An order number does not need to be obtained before scheduling elective outpatient diagnostic imaging services.