CONTACT INFORMATION:
Three Column Table
Q: I received a bill because I did not show the Medical Card at the time of service. Do I need to pay this bill?A: Showing your medical card is a responsibility each time you get medical care. If you do not show your medical card, you may be responsible for the bill. If you are assigned to Healthy Blue, Aetna Better Health, Sunflower Health Plan, or United Healthcare Community Plan - Kansas, call your KanCare plan for help understanding the bill. If you are not assigned to a KanCare plan or need more help, call Kansas Medical Assistance Program (KMAP) Customer Service.
Q: What should I do if I received a bill and I could not show my card at the time of service because my Medicaid was approved after the service? A: If you are approved for Medicaid coverage after getting a medical service, contact your provider and let them know that you have been approved for Medicaid. If you received a bill for these services and are assigned to Healthy Blue, Aetna Better Health, Sunflower Health Plan, or United Healthcare Community Plan - Kansas, call your KanCare plan for help understanding the bill. If you are not assigned to a KanCare plan or need more help, call KMAP Customer Service.
Q: My provider told me that he would accept my Medical Card, but I just received a bill from my provider. Do I have to pay this bill? A: Providers can bill you for some things (like a copayment) but are not able to bill you for other things (such as the difference between what Medicaid pays and their fee for the service). Do not ignore the bill. Contact the provider to discuss the bill. If you need help with this issue and are assigned to Healthy Blue, Aetna Better Health, Sunflower Health Plan or United Healthcare Community Plan - Kansas, contact your KanCare plan for assistance with the bill. If you are not assigned to a KanCare plan, call KMAP Customer Service. There is additional information listed in the Member Booklet, found under
Member Publications on the Member home page of the KMAP Public Portal.
Q: I received a bill. Do I need to pay this bill? A: If you receive a bill for a service, you should contact the provider or the KMAP Customer Service. If you are assigned to Healthy Blue, Aetna Better Health, Sunflower Health Plan or United Healthcare Community Plan – Kansas, contact your KanCare plan for assistance with the bill. The KanCare plan will work with your provider.
Three Column Table | Agency | Telephone | Website |
KMAP Customer Service/ROSIE
If you are not assigned to a KanCare plan and have questions about:
| 1-800-766-9012
TDD/TTY: 1-800-766-3777
Business hours:
Monday – Friday
7:30 AM – 5:30 PM | https://portal.kmap-state-ks.us/PublicPage/Public/Login
Log on and password required.
|
Aetna Better Health of Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-855-221-5656
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.aetnabetterhealth.com/kansas
|
Sunflower Health Plan
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-644-4623
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.sunflowerhealthplan.com
|
United Healthcare Community Plan - Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-542-9238
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.uhccommunityplan.com
|
Healthy Blue
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-833-838-2593
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.choosehealthyblue.com/ks/
|
Q: How do I submit a claim to the Kansas Medical Assistance Program (KMAP)?A: Providers have several avenues to submit a claim:
- Electronic Data Interchange (EDI)
- KMAP Provider Secure Portal
- Provider Electronic Solutions (PES) – typically used for Long Term Care Claims only
Q: Can I submit Managed Care Organization (MCO) claims through KMAP?A: Yes. Providers can submit MCO claims via the KMAP Provider Secure Portal or EDI. KMAP will forward them to the appropriate MCO for processing/adjudication. However, providers will not be able to adjust or void these claims using the KMAP Provider Secure Portal. The process of passing claims to the MCOs is referred to as Front End Billing (FEB).
Q: Are there instructions for submitting a claim using the KMAP Provider Secure Portal?A: Yes. You can find training videos, billing packets, and reference guide materials under
Helpful Information on the Provider page of the KMAP Public Portal.
Q: How can I find out why my Fee for Service (FFS) claim denied?A: On the Remittance Advice (RA), KMAP provides Explanation of Benefits (EOB) information which explains why the claim was denied. The denial reasons are also explained when viewing the claim on the KMAP Provider Secure Portal.
You have the option to obtain denial reasons one of the following ways:
- Paper RA – KMAP provides EOB information which explains why the claim denied
- Online – Use the KMAP Provider Secure Portal to view the RA or FFS claim
- Phone – Call the KMAP Customer Service Provider line
Q: Can I adjust a FFS claim using the KMAP Provider Secure Portal?A: Yes. Paid FFS claims can be adjusted using the KMAP Provider Secure Portal by editing the claim. FEB claims submitted to be forwarded to the MCOs, cannot be adjusted via the KMAP Provider Secure Portal.
Denied claims cannot be adjusted, a new claim will need to be submitted
If a claim is more than two (2) years old, the adjustment request must be submitted on a paper red and white claim form with proof of timely filing
The KMAP Provider Secure Portal cannot be used if a claim is more than 12 months old AND you are changing the member ID, billed amount, date(s) of service, or adding details
More information on Timely Filing can be found in the General Billing Fee-for-Service Provider Manual on the
Provider Manuals page of the KMAP Public Portal.
Q: Can a FFS claim be voided using the KMAP Provider Secure Portal?A: Yes. Paid FFS claims can be voided using the KMAP Provider Secure Portal by accessing the claim and choosing the Void option. Once a claim has been voided, it cannot be adjusted or voided. To replace the claim, if applicable, a new claim will need to be submitted.
FEB claims submitted to be forwarded to the MCOs cannot be voided via the KMAP Provider Secure Portal.
Q: How long does it take for an FFS claim to process?A: A clean claim will be processed in less than 30 days.
Q: The paper claim I sent in was keyed wrong, what do I do?A: If you believe a paper claim was not keyed correctly, contact KMAP Customer Service.
Q: When do I enter TPL payment information at the header level instead of the detail level on a claim?A: Claim Adjustment Reason Code (CARC) information should only be submitted in the CARC portion of the TPL/Medicare section if it applies to the entire claim. This is considered the header level. There are only two situations where payment information is added here on professional claims:
- If there is only one line item, or
- If the primary insurance only pays at the header level and there is no detail level information available.
For institutional inpatient claims, enter this information at the header level in the TPL/Medicare section. If CARC information is added here, you cannot add it a second time in the detail section under Payer Information. The claim will not balance and will not process.
Q: I am getting a balancing error. What information do I need to verify to submit?A: Each sum of the line detail payments must balance to the header paid amount; meaning, everything must balance. If the billed amount is $100.00 and TPL/Medicare paid $25.00, you need to have $75.00 worth of CARC information added at the detail level. All detail lines for CARC information plus the TPL/Medicare paid amount equals the total billed amount. In addition, CARC information cannot be submitted at both the header and detail level.
The header level is defined as the TPL/Medicare section, and the detail level is defined as the Payer Information section. Each line item must balance individually. If your claim is not balancing: Verify the CARC information is not entered at both the detail and header level. The CARC information can only be entered once per payer. Verify the full Paid Amount is in the header TPL/Medicare section. Verify the contractual obligation (CO) or write-off amount information is in the CARC section
Q: How do I enter information when multiple TPL policies are involved?A: Both TPL payments must balance to the billed amount. If a payment is made by two or more payers before billing KMAP, the secondary payer information must still balance to the billed amount. If Payer 1 pays $100.00 toward a $200.00 billed amount, Payer 2 needs to include an explanation for the difference between the payment amount and the billed amount balance. Payer 2 must proceed as if a primary payment was not made when explaining exactly what equals the billed amount. If an explanation is not provided on the explanation of benefits (EOB) from the primary insurance, indicate an adjustment for the primary payer's payment with another adjustment (OA) code.
Example: The billed amount equals $200.00. Payer 1 made a $100.00 payment that is entered in the Paid Amount field of the TPL/Medicare section. In the Payer Information section, enter CARC information for PR 1 Deductible as $25.00, PR 2 Coinsurance as $25.00, and CO 45 Contractual Obligation as $50.00. Payer 2 made a $50.00 payment that is entered in the Payer 2 Paid Amount field of the TPL/Medicare section. Payer 2 must balance to the full billed amount. To count toward the $200.00 billed amount, enter CARC information for OA 94 Other Adjustment as $100.00 and CO 45 Contractual Obligation as $50.00.
Q: How can I enter negative amounts?A: If another insurance or Medicare pays more than the billed amount, the CARC information is entered as a negative amount to balance the billed amount and the total paid amount including adjustments by the other insurance or Medicare. This usually occurs with claims billed by rural health clinics, federally qualified health centers, and Indian Health Services; however, this applies anytime the primary insurance pays more than the billed amount.
Example: The billed amount equals $200.00. Payer 1 made a $300.00 payment that is entered in the Paid Amount field of the TPL/Medicare section. In the Payer Information section, enter CARC information for PR 1 Deductible as $25.00, PR 2 Coinsurance as $25.00, and OA 94 Other Adjustment as $-150.00.
Q: When do I enter CARC 192?A: CARC 192 indicates CARC information is not provided by the primary insurance. This is used anytime you receive a non-HIPAA compliant EOB from the primary insurance.
Q: What information needs to be included to process a paper claim?A: If a member has other applicable insurance and you are submitting a paper claim, you must attach a copy of the EOB and/or remittance advice (RA) from the other insurance company for all affected services. An adjustment group code must always be used in conjunction with a CARC to show the liability for amounts not covered or to identify a correction or reversal of a prior decision. Acceptable group codes include:
- Contractual Obligation (CO)
- Patient Responsibility (PR).
- Payer- Initiated Reductions (PI)
If the other insurance does not specify this information, write the information on the EOB or RA. If the EOB from the other insurance does not include all proportioning of the monies, the claim will be returned to the provider (RTP). The EOB must clearly indicate the paid amount, patient responsibility, and contractual write-off. If the EOB does not specifically indicate these things, write the information on the face of the EOB.
Example: Paid Amount equals $100.00; PR 1 Deductible equals $25.00, and CO 45 Provider Write-off equals $75.00.
Q: What are the definitions for the group codes?A: The group codes are as follows:
CO - Contractual Obligation. This group code is used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment. Generally, these adjustments are considered a write-off for the provider and are not billed to the patient.OA - Other Adjustment. This group code is used when no other group code applies to the adjustment.PR - Patient Responsibility. This group code is used when the adjustment represents an amount that should be billed to the patient or insured. This group code is typically used for deductible and copayment adjustments.PI - Payer Initiated Reduction. This code is used when, in the opinion of the payer, the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and the payer (such as medical review or professional review organization adjustments).If the group code is not provided by the primary payer, use your best judgment to identify which group code matches the CARC used.
Q: If I need to file an appeal, what are the options?A: For FFS claims, the appeal process is documented under the Appeal Rights section of
Helpful Information, located on the Provider page of the KMAP Public Portal.
For KanCare claims filed with an MCO, contact the MCO directly.
Q: What is EDI?A: EDI stands for Electronic Data Interchange. This is the method you can use to submit claims electronically through Provider Electronic Services (PES), a clearinghouse, or software you use. More information can be found under EDI on the Kansas Medical Assistance Program (KMAP) Public Portal.
Q: Do I have to fill out an EDI application?A: If you are an active enrolled provider with KMAP, you must fill out an application unless you will only be using the KMAP Provider Secure Portal. The application is used when you plan to submit claims electronically by uploading files through the KMAP Provider Secure Portal or receive the X12 835 either through a clearinghouse or through the portal.
If you select a clearinghouse that is not approved to submit to KMAP, the clearinghouse will have to test prior to making any submissions on your behalf.
The application can be found on the KMAP Public Portal under Provider Publications, Forms, Provider Information – EDI – Electronic Claims Submission Form.
Q: How do I know if KMAP has authorized my clearinghouse or billing agent?A: Contact the EDI department via telephone or email (see Contact Information Section). Provide them with the name or Trading Partner ID number of your clearinghouse or billing agent.
Testing is required prior to approval. You will receive an email from the EDI helpdesk informing you the testing has passed and you are approved to submit data to the KMAP production environment. The production URL will be included in the approval email.
Q: Can I file everything to KMAP electronically?A: There might be some instances when you are required to send documentation to support your claim (for example, EOB or medical necessity). If you use the KMAP Provider Secure Portal, you can use the hard copy attachment and submit claims electronically. If you use a clearinghouse or batch billing software, you would not be able to file these types of claims electronically.
Q: Can I use a clearinghouse to submit my claims electronically?A: Yes, you can. The clearinghouse you choose to work with will need to test for Health Insurance Portability and Accountability Act (HIPAA) compliance with our EDI department before you can begin using them for your transactions.
Q: I have software which will allow for me to submit batches of claims. Is this acceptable to use with KMAP?A: Yes, you can potentially use this software for batch submission if the software submits the batch in the X12 837 or pharmacy NCPDP format. Contact the EDI department for instructions on how to begin testing for HIPAA compliance.
Q: What are the advantages of filing electronically?A: One of the big advantages of filling electronically is the speed at which the claim is processed. Electronic claims can process within hours, whereas paper claims can take (on average) eight days from start to finish. Some other advantages are that you would save money on ink for your printer, postage, and paper.
Q: What do I need to do to be able to submit claims electronically to KMAP?A: Contact the EDI department. They will be able to tell you the steps to take to begin testing with KMAP for HIPAA compliance on your electronic transmissions.
Q: Do I have to pay to submit claims electronically?A: KMAP does not charge providers directly to have claims submitted. If you use a clearinghouse, they may charge you a fee.
Q: Why do I need to test if I have been submitting electronically?A: HIPAA regulations require that all EDI transactions are HIPAA compliant.
Q: Which HIPAA transactions will KMAP support?A: Refer to the
HIPAA Companion Guides found on either the Publications or EDI page of the KMAP Public Portal.
EOB 0003 - Beneficiary ineligible for all or a portion of the service dates billedThis edit posts when the member (beneficiary) is not eligible for the dates of service billed on the claim. If this is the case, please verify proof of coverage for the member for the dates of service billed. Verify the dates of service on the claim are correct. If the member was not eligible for the dates indicated on the claim, the member is responsible for the charges.
EOB 0015 – Duplicate of claim paidThis edit posts if the detail is in paid status and the same services are billed again for a member. Please refer to previous payments and Remittance Advices (Ras) to find the previous payment.
EOB 0032 – Beneficiary ID number incorrect or missing. Use ID card to correct claim form and resubmitThis edit will post if the member ID number on the submission does not match the member ID in Kansas Modular Medicaid System (KMMS). Verify the correct ID number and name. The easiest way to correct the ID number or name on the claim, is by using the Kansas Medical Assistance Program (KMAP) Provider Secure Portal. Once the member ID number is entered on the claim, the system auto-populates the name and date of birth associated with the ID number indicated.
EOB 0183 – This claim is beyond 12 months from the date of service and cannot be paidThis edit posts if the dates of service are more than 12 months old and there is no proof of timely filing on the claim. If you have proof of timely filing, resubmit the claim with the appropriate information. If you do not have proof of timely filing, your claim will be denied, and you will have to write off the charges.
Timely Filing guidelines can be found in the General Billing Fee-for-Service Provider Manual on the
Provider Manuals page of the KMAP Public Portal
EOB 0185 – Bill member's other insurance firstThis edit will post if KMAP has a Third-Party Liability (TPL) policy on file for the member. Please verify the TPL information on the member's eligibility and resubmit with the appropriate TPL payment information.
EOB 0342 – Procedure code is noncovered for this provider type and specialtyThis edit posts if the type and specialty of the provider are not covered for the procedure code billed. Please check your coding. This could be based on the provider type and specialty for the billing provider or the performing provider.
EOB 0369 – Alien Medical Services (SOBRA – Sixth Omnibus Budget Reconciliation Act)This edit posts when the member has a SOBRA benefit plan, and the service is non-covered under that plan. SOBRA is the federal plan acronym for alien citizens. Medical services are only allowed for emergency services. Routine labor and delivery charges related to childbirth are considered for payment when billed with the appropriate KMAP SOBRA diagnosis code. Services for male patients and services for female patients not related to labor and delivery require MS2156 medical review. Providers can contact the KanCare clearinghouse to initiate a request for MS2156 medical review decision.
EEOB 0451 – Physicians not in a group practice must use the same performing provider number as the billing providerThis edit will post when the claim indicates a group number as the performing or rendering provider. This can be corrected on the KMAP Provider Secure Portal by logging on, finding the claim, and making the appropriate changes to the performing provider field on the claim.
EOB 0818 – Claim denied. The sum of other insurance, noncovered charges, and/or other party liability exceeds the total amount billed/allowedThis edit posts when the payments of other insurance are more than the amount which is being billed to KMAP.
Verify that all information is correct and resubmit the claim to KMAP for processing
EOB 1455 - The member birth date is missing, invalid, or disagreeThis edit will post if the date of birth on the claim does not match the date of birth in KMMS. The easiest way to fix this claim is to bill the claim using the KMAP Provider Secure Portal. Once the member ID number is entered on the claim, the system auto-populates the name and date of birth associated with the ID number indicated.
EOB 1685 – Cannot void/adjust a denied claimThis edit posts when the provider is attempting to adjust a denied claim. KMAP does not allow denied claims to be adjusted. All claims should be submitted as clean claims unless the provider is needing to adjust a paid claim.
EOB 1718 – Valid Present on Admission Indicator is required for each diagnosisThis edit will post on inpatient claims when a diagnosis code does not have a Present on Admission Indicator. Indicator requirements differ for paper and electronic claims, for more information on the requirements please refer to KMAP
General Bulletin 17004.
Bulletins can be accessed on the
Provider Publications page of the KMAP Public Portal.
EOB 2020 – Medically unlikely units of serviceThis edit will post when the billed units exceed the maximum allowed by the Centers for Medicare and Medicaid Services (CMS). More information regarding the maximum allowed units can be found on the
CMS Website.
EOB 7000 – ProDUR (Prospective Drug Utilization Review) Alert- Refill too soonThis edit posts when a claim is submitted for a refill too soon.
EOB 7503 – Missing/Invalid ProdDUR ReasonThis edit may post to a pharmacy claim for various reasons. More information on resolving a ProDUR denial can be found in the Pharmacy Fee-for-Service Provider Manual on the
Provider Manuals page of the KMAP Public Portal.
EOB 9017 – Claim treated as an adjustment. Original ICN (Internal Control Number) not foundThis edit posts when a claim is submitted as an adjustment but there is no paid claim indicated on the submission. To correct this, resubmit the claim and include the ICN of the paid claim you are attempting to adjust. If there is no paid claim currently on file, submit the claim as a clean claim.
EOB 9018 – Claim treated as an adjustment. Claim has already been adjustedThis edit posts when a claim is submitted as an adjustment but the paid claim in history has already been adjusted. To correct this, resubmit the adjustment for the adjusted claim.
EOB 9943 – Other insurance paid amount is not equal to the header/detail level billed amount minus the sum of all header/detail other insurance adjustment amountsThis edit will post when a claim and the other insurance Explanation of Benefits (EOB) does not balance. Resubmit the claim ensuring the Primary EOB and claim balance. To assist with balancing paper claims, KMAP has published a TPL Claim Adjustment Reason Code (CARC) & Remittance Advice Reason Code (RARC) Form.
The TPL CARC & RARC Form is in the Forms Section on the
Provider Publications page of the KMAP Public Portal.
Q: How can I get a copy of the Fee Schedule?A: There are current copies of the Fee Schedule available under the
Interactive Tools section of the Provider page on the Kansas Medical Assistance Program (KMAP) Public Portal.
Select Download Fee Schedules, then scroll to the bottom of the window and click Accept. The KMAP Fee Schedules window displays. There are two boxes with drop-down menus from which to select. From the Program drop-down list, you can select TXIX (Title 19), QMB, or MediKan. Once you have selected one of those options, the Select Rate Type drop-down becomes available. Select the rate type which best describes the services being rendered. Depending on which selections you make, there will be at least a current version and possibly historical versions as well.
How do I know which program to selectLook at the benefit plan for which the member is eligible. If you do not see the member's plan listed, select TXIX. This will show you the max fee allowed.
Q: What is the process if the provider disagrees with a denial related to National Correct Coding Initiative/Medically Unlikely Edits (NCCI/MUE)?A: If a provider does not agree with a claim denial, appeal options are available. The provider can request an appeal review through the grievance and appeal team. Providers can contact Kansas Medical Assistance Program (KMAP) Customer Service for assistance. Providers are also able to dispute denied claims through fair hearing. Contact information is listed on their remittance advice. Please refer to Section 5300 in the
General Billing Fee-for-Service Provider Manual on the
Provider Manuals page of the KMAP Public Portal, for more information.
Q: Will KMAP allow overrides of NCCI using the modifiers like Medicare?A: KMAP recognizes all the modifiers identified in the NCCI documentation provided by Centers for Medicare & Medicare Services (CMS). However, in some cases state policy indicates that payment will not be made. In these situations, the outcome of the claims will not be the same as when processed by Medicare. For example, if IV services are provided on the same day as an emergency room (ER) visit, state policy clearly indicates that those services are included as part of the ER visit and no additional payment will be made even with a modifier.
Q: Are the Medicaid NCCI/MUE guidelines the same as the guidelines currently used for Medicare?A: The Kansas Department of Health and Environment (KDHE) has reviewed the files and there are several codes Medicare edits for that Medicaid does not. For more details, see the CMS website.
Q: Are providers supposed to bill KMAP like they bill Medicare when they exceed the MUE limitation? Example: For Medicare we bill the allowed MUE edits on one line, then bill any units that exceed the MUE limitation on a second line with a modifier?A: Providers should bill KMAP in the same manner they bill Medicare. If the number of units billed on one line exceeds the MUE limitation, the entire line item will be denied.
Q: Will KMAP allow overrides/payment for units over the MUE unit limitation with modifiers, like Medicare?A: If the provider bills more than the maximum units allowed per MUE, the entire line item will be denied. Reference the CMS website for additional information.
At this time, KMAP will not allow payment for units above the MUE limitation, even with modifiers. KMAP is in the process of reviewing the policy and edits to see if there are situations where this could be allowed.
Q: Where can I get more information about HIPAA?A: The
Centers for Medicare & Medicaid Services (CMS) website provides more information about the federal law.
Select Download Fee Schedules, then scroll to the bottom of the window and click Accept. The KMAP Fee Schedules window displays. There are two boxes with drop-down menus from which to select. From the Program drop-down list, you can select TXIX (Title 19), QMB, or MediKan. Once you have selected one of those options, the Select Rate Type drop-down becomes available. Select the rate type which best describes the services being rendered. Depending on which selections you make, there will be at least a current version and possibly historical versions as well.
Where can I find the KMAP HIPAA Companion Guides?The fiscal agent maintains a series of
HIPAA Companion Guides located on the Publications and EDI pages of the Kansas Medical Assistance Program (KMAP) Public Portal. The HIPAA Companion Guides document how local codes will be used in conjunction with the national formats. The Implementations Guides for HIPAA x12 transactions are available for purchase from the x12 Store.
IMPORTANT: The Kansas Medical Assistance Program (KMAP) Public Portal can be accessed by most of the web browsers. For optimal performance use Google Chrome, Microsoft Edge, or Mozilla Firefox.Training videos and information can be found under
Helpful Information on the Provider page of the KMAP Public Portal. Also accessible via the
Provider Training Materials link on the Provider home page.
Q: How do I register for the KMAP Provider Secure Portal?A: There are instructions and a training video available under
Helpful Information on the Provider page of the KMAP Public Portal. Also accessible via the
Provider Training Materials link on the Provider home page.
When your organization enrolls as a Medicaid Provider, you will receive a welcome letter with your 14-digit KMAP Provider ID. You will receive a second letter containing a web PIN enabling registration for the KMAP Provider Secure Portal. You can register by going to the
KMAP Public Portal, clicking ‘REGISTER’ under the Provider/Drug Labeler section, and selecting the correct account type from the dropdown
If registering as the organization’s Administrator, select ‘Provider’ from the ‘Register as’ dropdown. You will then be prompted to enter your Provider Login ID, which is the first 10 digits of your 14-digit KMAP Provider ID from your welcome letter. The next field is the Provider PIN, which is sent in a separate PIN letter for security purposes. Pay close attention to how the PIN is entered as it is case sensitive
If registering as a Delegate, select ‘Delegate’ from the ‘Register as’ dropdown. The KMAP Provider ID and PIN are not used. You will enter a username, password, and other identifying information. Once you have registered, you will receive an email prompting you to log into the secure portal. Log in and retrieve your relationship code from Maintenance, Portal Profile Maintenance. Send your relationship code to your organization’s Administrator. The Administrator will use this information to assign service location(s) and security functions. Once your administrator has confirmed your access has been granted, log into the secure portal and confirm you can see the expected menu options
If you have issues with this process and have reviewed the
Helpful Information, contact KMAP Customer Service for assistance.
Q: How can an Administrator add registered Delegates to their organization?A: To grant access to a registered Delegate, the Administrator must have the Delegate’s last name and relationship code. Delegates must first
register, then retrieve their relationship code from Maintenance, Portal Profile Maintenance. Next, the Administrator should log into their account and go to Maintenance, Manage Delegates, Add Registered Delegate. Copy and paste the Delegate’s relationship code into the appropriate field to prevent errors.
Q: An Administrator has granted access to a Delegate, why can’t the Delegate see the menu options?A: Have both the Administrator and Delegate log into their accounts. Confirm that both users see ‘Provider Portal’ in the upper left corner of their screen.
Compare the relationship code in the Delegate’s account under Maintenance, Portal Profile Maintenance with the relationship code the Administrator has entered at Maintenance, Manage Delegates. Verify that the codes match.
Have the Delegate go to Maintenance, Switch Provider and confirm a provider has been selected.
Q: How often will my password expire?A: Passwords expire every 120 days and must be changed. Notifications will be sent via email allowing you the ability to use the self-service password reset process. The email originates from
kmmsidentitymanagement@gainwelltechnologies.com.
Q: How will users be set up to view information for every clinic, doctor, or facility for which they bill?A: When registered, there will be an Administrator for the organization. All service locations (14-digit KMAP Provider ID) associated with the base ID (first 10 digits of the 14-digit ID) will be viewable to the Administrator.
All other users must register as a Provider Delegate(s). Once the Provider Delegate has registered, the Administrator can grant access to service location(s) and security functions to each Provider Delegate.
For more information, please see
Provider Portal Reference Guide and KMAP Portal Registration videos, found under
Helpful Information on the Provider page of the KMAP Public Portal. Also accessible via the
Provider Training Materials link on the Provider home page. If additional assistance is needed, call KMAP customer service.
Q: Will my Provider Delegates lose access if the Provider (Administrator) account is locked (due to invalid password etc.)?A: Provider Delegates will not lose access if the Provider (Administrator) account is locked.
Q: There is a yellow banner running across the top of the KMAP site – what does it mean?A: The yellow banner is our method of drawing attention to key items, such as planned maintenance outages for the site.
Q: What is a Broadcast Message?A: Broadcast Messages are used to communicate important updates to providers related to KMAP. These are displayed once logged into the KMAP Provider Secure Portal.
Q: How can I obtain a copy of provider manuals and bulletins?A: You can view your Provider Manual and Bulletins on the
Provider Publications page of the KMAP Public Portal.
Q: Where can I track Open and Closed Claims Resolution Logs (CRLs)?A: The Open and Closed Claims Resolution Logs for KMAP and KanCare are posted as Bulletins on the KMAP Public Site. Bulletins can be accessed on the
Provider Publications page of the KMAP Public Portal.
Q: Where are Reference items available?A: You can view such items as the Fee Schedules, Reference Codes, Taxonomy Cross Reference, TPL Non-Covered Procedure Codes, and Hospital DRG Weights and Rates, under the
Interactive Tools section of the Provider page on the KMAP Public Portal.
Q: Can I access my organization’s Remittance Advice (RA) via the KMAP website?A: Any RA issued after April 4, 2022, is available on the KMAP Provider Secure Portal. If you are a Provider Delegate and cannot access RAs, you will need to work with your Administrator to obtain access.
Q: What is available via the KMAP Provider Secure Portal?A: Full instructions on the use of the KMAP Provider Secure Portal can be found by accessing the
Provider Portal Reference Guide under
Helpful Information, on the Provider home page. Below are a few of the key functions:
- Member Eligibility Verification
- Claims Submission and Review
- Electronic Claims Batch Submission
- Electronic Remittance Advice (RA) Access
- Updates/Maintenance to Provider Enrollment Data
- Prior Authorization (PA) Requests for Fee-for Service (FFS)
Q: What information is displayed when checking Member Eligibility on the KMAP Provider Secure Portal?A: The following key items are available for the month of the search:
- Active Medicaid Benefit Plan(s)
- Copayment Information (Fee-for-Service)
- Current Living Arrangement
- EPSDT (KBH) Well Child Service Information
- Spenddown Information
- If spenddown is met, the system will not return any spenddown segment
- If spenddown is not met, the base period dates, total spenddown and remaining spenddown will display
- Third-Party Liability (TPL) - Including Commercial Carrier and Medicare Information
Q: What is available via the KMAP Provider Secure Portal?A: Full instructions on the use of the KMAP Provider Secure Portal can be found by accessing the
Provider Portal Reference Guide under
Helpful Information, on the Provider home page. Below are a few of the key functions:
- Member Eligibility Verification
- Claims Submission and Review
- Electronic Claims Batch Submission
- Electronic Remittance Advice (RA) Access
- Updates/Maintenance to Provider Enrollment Data
- Prior Authorization (PA) Requests for Fee-for Service (FFS)
Q: Where can I get more information about different Member benefit plans?A: The majority of members are part of one of these two (2) major benefit plans:
- Title 19 (Full Medicaid) – Most members are assigned to a KanCare MCO(s)
- Title 21 (CHIP - Children’s Health Insurance Plan) – All members are assigned to a KanCare MCO
For more information regarding the different benefit plans access the Member Booklet. This document is found under
Member Publications.
Q: How do I review my patient’s treatment history?A: From the main menu of the KMAP Provider Secure Portal, hover over Eligibility and click Treatment History. Enter the Member ID or a combination of the Last Name, First Name and Birth Date in the Member Information panel.
Q: What should we do if the member does not present their Medicaid ID card at their appointment?A: Providers have several options for verifying coverage if a member does not present an ID card at the time of services:
- Online – via the KMAP Provider Secure Portal
- Interactive Voice Response (IVR) – call 800-933-6593 and use the automated system
- Phone – call KMAP customer service and request to speak with an agent
Q: How can a Medicaid Member obtain a replacement ID Card?A: Members assigned to a KanCare MCO plan can contact their MCO and request a replacement card.
Members not assigned to a KanCare plan, can contact KMAP Customer Service.
Q: How is the Kan Be Healthy (KBH) status updated?A: A member’s KBH status is updated by claims submitted and satisfies the following conditions:
- The member is actively enrolled in the TXIX or TXXI program
- The member is age 0-18 years
- The member ID and name match
- The code billed on the claim is KBH specific
Q: Where can I find information on the Kan Be Healthy Program?A: Refer to the
KAN Be Healthy - Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Provider Manual on the
Provider Manuals page of the Kansas Medical Assistance Program (KMAP) Public Portal. The manual includes an all-inclusive list of Common Procedure Terminology (CPT) procedure codes that will update the KBH screening date.
Q: What is Managed Care?A: Managed Care provides states with some control and predictability over future costs. Managed Care programs may provide an opportunity for improved.
Q: Who are the Managed Care Organizations (MCOs)?A: The State of Kansas currently has contacts with the three (3) following MCOs:
- Aetna Better Heath of Kansas
- United Healthcare Community Plan – Kansas
Q: How do I contact the MCOs?A: Reference the Contact Information section of these FAQs.
Q: Are all members assigned to an MCO?A: The majority of members are assigned to a KanCare MCO, however there are some members that are not assigned and are considered Fee-for-Service (FFS). Below are some benefit plans that remain FFS:
- SOBRA (Sixth Omnibus Budget Reconciliation Act)
- Qualified Medicare Beneficiary (QMB) Only
- AIDS Drug Assistance Program (ADAP) Only
- Incarcerated Members (INMAT)
- Presumptive Eligibility for Pregnant Women (PEPW)
- Some State Hospital Residents in Specific Categories
Q: Does each MCO have its own Preferred Drug List (PDL)?A: No. The State of Kansas maintains the PDL.
Q: What is PES?
A: Provider Electronic Solutions (PES) is software provided by the fiscal agent for providers to use to batch and bill claims electronically and is typically used for Long Term Claim submission.
Q: How can PES benefit me as a provider?
A: If you are billing the same services for the same members month after month, you can just make some minor changes to your batches and resubmit all those claims. For example, if you are a nursing home and billing for the room and board for the same members, you would have submitted a batch for last month. After this month is over, you can access the last batch you sent, change the dates of service for the entire batch, and then resubmit them all again with the corrected information. For additional information on the benefits, contact the Kansas Medical Assistance Program (KMAP) Electronic Data Interchange (EDI) team.
Q: Can PES be installed multiple times?
A: No. Only one installation of PES will work on a single personal computer (PC). However, it can be loaded to multiple PCs within the same office. PES supports billing for as many providers as necessary with a single installation.
Q: What operating system does PES require?
A: PES requires Windows 98/2000/XP/Vista/7/10. The system requirements are posted on the KMAP Public Portal under EDI.
Q: How many members can be loaded into a list?
A: There is no limit on the number of members that can be loaded.
Q: How many detail lines per claim type are allowed on PES?
A: PES limits the number of lines to 99 for Institutional claims and 50 for Professional claims.
Q: On PES Pharmacy claims, where does the TPL information need to be entered?
A: TPL information is entered on the Service 2 tab (Other Coverage).
Q: I want to back-up my database. How do I do that?
A: Your database is a file named ksnewecs.mdb. Perform a search on your computer (Start-Search-Find Files or Folders) for this file and copy it to another location on your computer. If you are going to rely on this file for current information, remember to make frequent copies of the file. The PES User ID and Password used at the time the database is copied will be the same that you use if you choose to restore PES with a previous database file. If you still have problems performing this task, contact the EDI team.
Q: I used to transmit just fine, but now PES tells me my transmission failed. What is wrong?
A: Check the communication log under Communication-View Communication Log. If the log says, “Invalid ID/Password," chances are you have changed the password on your web account but have not updated PES. To update PES, select Tools-Options-Batch and change the Web Password field to reflect what you currently use on the website. Then, try your transmission again.
Q: Will there ever be electronic attachments?
A: PES supports the Health Insurance Portability and Accountability Act (HIPAA)-compliant attachment control number. Providers should submit their claims with an attachment control number assigned by them. The attachment control number is then written on the attachment and mailed or faxed to KMAP where it will be paired up with the electronic claim.
Q: Can I view prior authorizations (PAs) and plans of care through the Kansas Medical Assistance Program (KMAP) website?A: Yes. You can view and submit PAs through the KMAP Provider Secure Portal. Once logged into the KMMS Provider Secure Portal, select Main Menu, Care Management, then Search Authorization Determination. When searching for a PA status, enter the information and click Search. When the results are returned, double-click on the PA number to display the View Authorization Details window. If you do not have the PA number, you need the member ID number and the date of service. The National Drug Code (NDC) or procedure code are optional search fields for more specific data..
Q: What is the protocol for Preferred Drug List (PDL) PAs?A: Pharmacies receive a determination at the time of billing a claim which either allows the claim to pay or directs them to contact the fiscal agent if a PA is needed. The fiscal agent processes PA requests received in accordance with the established contract protocol.
Q: What portion of the form should the doctor fill out and what portion of the form should the pharmacy fill out?A: Either the pharmacy or prescriber can request a PA, however, it is most often the prescriber who can answer the specific questions regarding the need for a particular drug.
In addition to processing requests through the Kansas Modular Medicaid System (KMMS) provider portal, PA requests can be submitted by telephone or fax. Requests received by telephone will still require a request form. The most current PA forms are posted on the Kansas Department of Health and Environment, Division of Health Care Finance (KDHE-DHCF) website under the General Clinical Prior Authorization section.
Clinical PA Drug Index lists drugs that require prior authorization. A link is provided to the policy criteria perimeters for coverage and a link to the required request form. Use the form(s) posted on the website when submitting a PDL PA request. Do not make copies and use them without periodically checking the website for the newest form.
Q: Where do I send pharmacy PA requests for Fee-for-Services (FFS) members?A: Providers who request PAs for FFS members need to continue to contact the fiscal agent by submitting the prior authorization request through the KMMS provider portal, telephone, or fax. Requests received by telephone will still require a request form.
If a member has coverage through KanCare, contact the member’s assigned Managed Care Organization (MCO) for PA
Q: Will there be a hard copy attachment option for PAs that require medical records, etc.?A: Providers submitting PA requests through the KMMS provider portal will be required to attach at least one file to send a request, typically the required pharmacy request form or general PA request form. Providers should attach proof of medical necessity, if applicable. Providers may indicate that records will be sent by mail or fax when submitting a request through the KMMS portal. PA requests may be pended while awaiting required forms or proof of medical necessity, for request decision.
IMPORTANT: The Kansas Medical Assistance program (KMAP) Public Portal can be accessed by most of the web browsers. For optimal performance use Google Chrome, Microsoft Edge, or Mozilla Firefox.Training videos and information can be found under
Helpful Information on the Provider page of the KMAP Public Portal. Also accessible via the
Provider Training Materials link on the Provider home page.
Q: How do I enroll as a KMAP provider?A: Access the
Provider Enrollment Wizard for new applications. A link to the Enrollment Wizard is available through the Provider Enrollment tile on the KMAP Home page. For additional questions, contact KMAP Provider Enrollment.
Q: Where can I find training documents for the new KMAP Portal?A: Training materials can be found under
Helpful Information on the Provider page of the KMAP Public Portal. Also accessible via the
Provider Training Materials link on the Provider home page.
Q: Can I submit a paper application or revalidations?A: No. Effective March 1, 2021, paper applications are no longer accepted. New applications and revalidations must be completed online using the following link:
https://portal-uatc-state-ks.us/PublicPageQ: To enroll in KMAP, does a physician need to have privileges at hospitals?A: This depends on the specialty selected. All required fields are indicated and will not allow you to progress through the application until the required data has been entered.
Q: Can the Provider Enrollment Fee be paid electronically?A: No, the State of Kansas does not offer that option.
Q: How do we make the provider application fee payment?A: Payment must be made in the form of a check or money order made out to the State of Kansas - Medicaid and sent to:
Provider EnrollmentPO Box 3571Topeka, KS 66601-3571Note the Application Tracking Number (ATN) on the check
Q: Does the provider application have to be done in a specific order?A: In the Provider Enrollment Wizard, you must complete each section in order. However, after you save a section, you can go back to the previous section.
Q: Will providers need to submit applications separately to each MCO to apply for the KanCare programs or will separate applications be needed?A: There are three enrollment options:
- Fee-for-Service (FFS) only
When the MCO or Both is selected, an additional field will appear asking you to select which MCO(s) you wish to enroll with.
Once the KMAP enrollment and screening processes are complete, the enrollment data and attachments will be forwarded to the selected MCO(s) so they can begin their credentialing and contracting processes.
Q: The ZIP code will be a 9-digit field. What if I only know the 5-digit ZIP code?A: You only need to enter the first 5 digits of the ZIP code. The KMAP Provider Enrollment Wizard will populate the remaining 4 digits.
Q: What Organization type should I list on the application?A: For an Individual within a Group (IG) the Organization, the Type must be (Individual). Other enrollments are dependent upon the enrolling entity.
Q: What is the ‘Pay To’ name on the application?A: The Pay To name can be either the legal tax name or the Business Name listed on the W-9.
Q: On the Address Page, will the Same as Above feature fill in all of the name and address fields if the Pay To Name is different than the enrollment name?A: The Same as Above option should only be used if the provider being enrolled should receive the payment for services rendered. This option brings over the enrollee's name and does not provide an option to change the Pay To Name. This could result in payments being made to the wrong name and address.
Q: When a Group/Facility has a Doing Business As (DBA) listed on the application, does the W-9 need to match?A: Yes, if a DBA name is listed on the application, it must match line 2 of the W-9. When there is no DBA name the Legal tax name must be listed.
Q: What is the ‘Service Location’ name on the application?A: The Service Location name must be the name used when billing claims.
Q: Will there be a separate application for each service location?A: For providers enrolling as an individual within a group, the provider will need to submit one application only. At the time the initial application is submitted, at least one group affiliation must be identified. The group must be enrolled prior to the individual.
For group enrollments, a separate enrollment must be submitted for each physical service location. A service location is defined as the physical address where services are being provided
Q: Will each new group application (for additional service locations) require the fee?A: The fee will be required for any qualifying enrollment. Reference KMAP
General Bulletin 22394 on the
Bulletins page of the KMAP Public Portal for the most current information regarding the enrollment fee.
Q: Will there be a separate application for each provider type?A: Yes. One application is needed for each provider type.
Q: How do I determine what a service location is and when a new enrollment is required?A: Any staffed, brick and mortar office where patients are seen daily, is considered a separate service location. A new enrollment is required for each service location, for each specialty, and for each tax ID number. For additional information refer to KMAP
General Bulletin 18223 on the
Bulletins page of the KMAP Public Portal.
Q: Will each service location have its own KMAP ID number?A: Yes. Each new service location enrolled with KMAP will have a unique 14-digit identifier.
Q: If a provider works in the same building under two (2) different Groups, does this require two (2) separate applications and two (2) different KMAP ID numbers?A: No. If the professional services are being billed by the Group, IG only needs to complete one enrollment and be affiliated with all the groups.
Q: If I rent space inside of another business and see patients within that structure, am I required to enroll with it as a separate service location?A: If the location has regular office hours and the space is rented in lieu of a free-standing office, the location is operating as its own practice location and a separate enrollment is required.
Q: Can more than one person have access to the KMAP Provider Enrollment Wizard to enroll our organization?A: Yes. More than one person can have access to the KMAP Provider Enrollment Wizard to enroll an organization, but only one person can access the application once the process has begun. Each application is assigned a personal ID number (PIN) and requires the individual who is entering and taking responsibility for its entire processing to register.
Q: Will there be retroactive dates for enrollment?A: KMAP will continue to allow retroactive dates for KMAP enrollment up to 12 months.
Q: If an individual other than the provider is filling out the application on behalf of the provider, does that individual have the authority to sign the application?A: Yes. If an individual is completing the application on behalf of the provider, they will have the authority to sign the application. However, the individual must sign their own name in the signature fields. Directions and specific details are available in KMAP
General Bulletin 17029 on the
Bulletins page of the KMAP Public Portal.
Q: Can the same email address be used for completing multiple applications for multiple providers?A: Yes. The same email address can be used to complete multiple applications, but access to the registered email address is required for forgotten passwords.
Q: In the instance that a group is loaded into the system in advance of an individual applying as a member of that group by selecting the group association, will the group information (such as pay to, and mailing address) be available as a dropdown for the individual?A: When an individual is applying as part of a group, they will not be prompted to enter a pay to or mail to address since the group will be billing on their behalf. All other information will need to be entered. A drop-down option will not be available. At the time of enrollment, IG will be required to supply the new 14-digit KMAP ID number of the group so the enrollments can be appropriately associated in the system.
Q: If a provider is associated with any group, do they need to provide that information in the application?A: Yes, they need to provide the KMAP Group ID number they want to be associated with.
Q: Will there be two signatures required: one on the provider agreement and one on the Disclosure of Ownership (DOO)?A: In the Provider Enrollment Wizard, only one electronic signature is required for the application. It applies to both the DOO and provider agreement.
Q: What is meant by "wet signature"?A: A wet signature is an original, ink signature that has not been photocopied.
Q: Can you choose more than one Tax Classification?A: No, the Tax Classification drop-down option includes all eligible classification and only one can be chosen.
Q: For the effective date on the taxonomy code, what date should be used?A: Bulletins can be accessed on the
Bulletins page of the public KMAP Public Portal.
Q: Is there a limit to the quantity or size of the documents in the Provider Enrollment Wizard?A: There is a size limit of 8 MB. If you need to upload a document that is larger than 8 MB, you can submit the document by fax or email.
Q: Does the Provider Enrollment Wizard allow users to enter a Council for Affordable Quality Healthcare (CAQH) number?A: Yes. The online application allows users to enter a CAQH number that will become available for the MCOs to use, as needed.
Q: Can we use the CAQH form to enroll with KMAP like most other carriers?A: No. You cannot use the CAQH form in place of a KMAP enrollment. There is a place on the application for the provider to enter their CAQH number for the MCOs to use as needed.
Q: Is there a requirement for taxonomies to match between a KMAP ID number and MCO provider record?A: No, there is not a requirement for taxonomies to match between KMAP and the MCOs. The requirement is only for the provider type and specialties to match. However, it is recommended that providers synchronize this data element between KMAP and the MCOs since the Taxonomy is used in identifying a unique provider which will be used in the processing of claims.
Q: Can we contract with an MCO for different provider types and specialties separate from KMAP?A: No, an MCO can only contract/credential a provider based on their KMAP enrollment. An MCO can contract for fewer provider types and specialties than KMAP, but an MCO may not contract/credential a provider for more or different provider types and specialties.
Q: Will the MCOs use the same effective date as KMAP or will the MCOs have their own credentialing date?A: The MCO assignment of effective date will continue to be independent of the KMAP enrollment process and is dependent on the MCO credentialing and contracting processes.
Q: If I am an individual completing an application on behalf of the provider, do I sign the MCO consent or do I enter the provider’s information?A: The individual completing the application should have the authority to sign on behalf of the provider and should sign their name.
Q: If I have multiple service locations, how do I obtain details regarding which providers are currently enrolled as an Individual within a Group and associated to each service location?A: Groups can login to the KMAP Secure Portal to view affiliated providers for the selected service location by selecting Maintenance - Manage my Information. For individuals that do not have access to the KMAP Secure Portal, an email request may be sent to:
Kansas-Provider-Enrollment@gainwelltechnologies.comQ: What Provider Types allow Sub NPI’s to be added to the Provider file?A: Only Hospitals are allowed to have Sub NPI’s.
Q: When adding an Individual to a Group will you still be required to include the employer W-9 and liability insurance declaration page?A: A list of required documentation will display on the attachments page of the Provider Enrollment Wizard. Please submit any documentation that is required.
Q: Where do we find the definition of a subcontractor?A: The definition of subcontractor is available on the
Disclosure of Ownership and Control Interest Statement located under the Provider Information heading on the
Forms page of the KMAP Public Portal.
Q: If total Medicaid capacity is requested and I have no limitation on the number of Medicaid patients who can be seen by my office, how should capacity be reported?
Access the Resume/Revalidate Enrollment page of the Provider Enrollment Wizard. The link is on the Home, Provider, and Provider Enrollment Application pages of the KMAP website.
Q: I have more than one location. Do I revalidate all of my locations at the same time? Not necessarily. Be sure to pay attention to which location you are revalidating.
Q: I was inactivated. How do I become active again? If you were inactivated for No Revalidation, you have 30 days from the revalidation due date to access the Resume/Revalidation page of the Provider Enrollment Wizard and complete your revalidation. If you were inactivated after 30 days from the due date, you will need to start a new application with the Provider Enrollment Wizard. Both links are available on the Home, Provider, and Provider Enrollment Applications pages of the KMAP website.
Q: What is the status of my application or revalidation? Access the Provider Enrollment Wizard for new applications. Click the yellow Menu box at the top of the web page. Under Provider Enrollment, click the Enrollment Status link.
Q: Will I be termed for not revalidating? Yes. You will be inactivated on the date stated on the letter sent prior to your revalidation due date. Once the revalidation is complete, as long as all enrollment requirements are met, you will be reinstated with no lapse in enrollment.
Q: Can local police stations do fingerprints? Yes, any law enforcement agency authorized to take prints is acceptable.
Q: Do individuals who reside outside of Kansas need to come to Kansas to have fingerprints taken? No, any law enforcement agency authorized to take prints is acceptable. The law enforcement agency taking the prints is responsible for mailing them to KDHE/DHCF in the addressed stamped envelope you provide.
Q: Do the FCBC requirements that apply to state Medicaid programs also apply to CHIP programs? Yes. Under 42 CFR 457.990(a), the Medicaid provider screening and enrollment rules at Part 455, subpart E, including the FCBC requirements discussed in these FAQs, apply to the state's CHIP just as they apply to the state's Medicaid program.
Q: How long does it take to complete the criminal background check once the fingerprints are received? The criminal background check will take 5-10 business days.
Q: In the case of a ""high"" risk provider enrolled in Medicare, is the state Medicaid agency required to conduct an FCBC if the provider wants to enroll (or re-enroll) in Medicaid or seeks to revalidate its current enrollment? Not if the state Medicaid agency is able to rely on Medicare's screening by confirming the provider or organization is a positive match. The state Medicaid agency will compare minimum required data elements through PECOS to verify a match between Medicaid and Medicare. Under 42 CFR 455.410(c), state agencies may rely on a provider's Medicare enrollment even if Medicare has not conducted an FCBC with respect to that provider.
Q: Is this mandatory per statutory requirement by regulation? Yes. CMS implemented provider screening requirements for Medicaid enrollment with federal regulations at 42 CFR Part 455 subpart E and at 42 CFR 457.990, which makes Part 455 subpart E applicable to CHIP. CMS published these regulations as a final rule in the Federal Register, Vol. 76, February 2, 2011, and were effective March 25, 2011.
Q: What if a provider or an owner of 5% or more doesn't submit fingerprints when requested to do so by a state Medicaid agency? Under 42 CFR 455.416, a state Medicaid agency must terminate or deny enrollment of a provider if the provider, or any person with a 5% or greater direct or indirect ownership interest, who is required to submit fingerprints: - Fails to submit them within 30 days of the Medicaid agency's request; or - Fails to submit them in the form and manner requested by the Medicaid agency. In both cases, the agency may allow the provider to enroll if the agency determines that termination or denial of enrollment is not in the best interests of the Medicaid program and documents that determination in writing.
Q: What if the law enforcement agency will not mail the fingerprints to KDHE/DHCF? Locate another law enforcement agency to take your prints.
Q: What if the results of a FCBC indicate that a provider or 5% owner has a criminal record? Under 42 CFR 455.416, a state Medicaid agency must terminate or deny enrollment of a provider if the provider, or any person with a 5% or greater direct or indirect ownership interest, who is required to submit fingerprints has been convicted of a criminal offense related to that person's involvement with the Medicare, Medicaid, or CHIP program in the last 10 years. The types of convictions that warrant denial of enrollment are at the discretion of the agency. The agency may allow the provider to enroll if the agency determines that termination or denial of enrollment is not in the best interests of the Medicaid program and documents that determination in writing that is available to CMS or OIG upon request.
Q: What provider categories are ""high"" risk? DME or Home Health Agency providers enrolled after March 2011 are designated a ""high"" category of risk. In addition, the state Medicaid agency must adjust the category of risk level to ""high"" when the following occurs: imposition of a payment suspension due to credible allegation of fraud; the provider has an existing Medicaid overpayment; or the provider has been excluded by the OIG or another Medicaid program in the previous 10 years.
Q: When a state Medicaid agency designates a provider or provider category as ""high"" risk, what is the state Medicaid agency required to do? Under 42 CFR 455.450(c), when a state Medicaid agency designates a provider as a ""high"" categorical risk, the agency must: - Perform the ""limited"" and ""moderate"" screening requirements specified at 42 CFR 455.450(a) and - Require the submission of a set of fingerprints in accordance with 42 CFR 455.434 and - Conduct a criminal background check.
Q: When are individuals required to submit fingerprints to have a FCBC conducted? Any person with 5% or more direct or indirect ownership interest in the provider designated with a ""high"" category of risk must submit fingerprints and undergo a criminal background check at initial enrollment, re-enrollment, and revalidation of enrollment.
Q: Who is required to submit fingerprints? If a state Medicaid agency designates a provider as a ""high"" risk, the provider and any person with 5% or more direct or indirect ownership interest in the provider must submit fingerprints and undergo a criminal background check, per 42 CFR 455.434(b). 42 CFR 455.101 defines an ""ownership interest"" as the possession of equity in the capital, the stock, or the profits of the provider. An ""indirect ownership interest"" means an ownership interest in an entity that has an ownership interest in the provider.
Q: Who is responsible for the cost of conducting FCBCs for ""high"" risk providers? The ""high"" risk provider is responsible to pay the costs associated with obtaining fingerprints. Under 42 CFR 455.460(a), state Medicaid agencies must collect application fees prior to executing a provider agreement and this application fee is intended to cover the costs associated with a state's Medicaid provider screening program, including the costs of conducting an FCBC on ""high"" risk providers.
Q: Who mails the fingerprint card to KDHE/DHCF? The law enforcement agency who takes the prints is responsible for mailing them to KDHE/DHCF in the addressed stamped envelope you provide.
Q: Why does a state Medicaid agency have to conduct FCBCs? The federal regulation at 42 CFR 455.410(a) provides that a state Medicaid agency must require all enrolled providers to be screened according to the provisions of Part 455 subpart E. These provisions require the agency to screen all provider applications for enrollment, including initial applications, applications for a new practice location, and applications for re-enrollment or revalidation, based on a categorical risk level of ""limited"", ""moderate"", or ""high"" (42 CFR 455.450). The agency must establish categorical risk levels for providers and provider categories who pose an increased financial risk of fraud, waste, or abuse to the Medicaid program. When the agency determines that a provider's categorical risk level is ""high"", or when the agency is otherwise required to do so under state law, the agency must require providers to consent to criminal background checks, including fingerprinting (42 CFR 455.434).
Q: How do I update my NPI with KMAP? To make a change to your NPI, the NPPES verification and written request on letterhead can be faxed to the Provider Enrollment team at 785-266-6112 or mailed to KMAP, Attn: Provider Enrollment, PO Box 3571, Topeka, KS 66601. If it is a correction to what is already on file, indicate that on the form. A note such as ""Correction to NPI information"" alerts the Provider Enrollment team to the change, rather than potentially causing them to think it is a duplicate update. If you have any questions, contact Provider Enrollment at 1-800-933-6593.
Q: Can I find provider enrollment forms on the KMAP website? Yes. Provider Enrollment forms are available on the Provider Enrollment Applications page of the KMAP website. Beneath each application is a generalized list of which types of providers would fill out that specific application. For additional questions, you can contact the Provider Enrollment team at 1-800-933-6593.
Q: How do I change my address and/or phone number? If you need to update your address or phone number with the fiscal agent or KMAP, fill out the Provider Update form under Provider Information on the Forms page and either mail or fax it to the Provider Enrollment team. This form can be faxed to 785-266-6112 or mailed to KMAP, Attn: Provider Enrollment, PO Box 3571, Topeka KS 66601. If you have any questions, contact Provider Enrollment at 1-800-933-6593.
Q: Which application should I fill out to enroll as a KMAP provider? Access the Provider Enrollment Wizard for new applications. The link is on the Home, Provider, and Provider Enrollment Application pages of the KMAP website. For additional questions, contact KMAP at 1-800-933-6593.
Q: I submitted my Provider Enrollment application. Now what are the next steps?A: Your application will be reviewed and screened against all the required data components. If approved, you will be notified of your approval, along with your Kansas Medical Assistance Program (KMAP) ID. If you chose to enroll with a Managed Care Organization MCO, your application and all attachments will be shared with the MCO(s).
Q: How long will it take for KMAP to process an enrollment for a provider?A: KMAP typically completes the initial process of a clean and accurate application within five business days. However, depending on the application additional items such as fingerprints, site visits and State review may be required and add time to the final processing. The enrollment process is delayed if the application is returned to the provider for corrections or is missing information.
Q: How long after KMAP approval will the MCO(s) receive notification and enrollment materials?A: Once a provider who requested to enroll with an MCO is approved by KMAP, the information is sent to the MCO(s) the same day.
Q: How long after the MCOs receive the approved information do they have to process an application?A: The MCOs have 90 days to credential after receipt of information and 30 days to contract once credentialing is approved.
Q: Will providers have access to their enrollment information to make updates such as location, additions, deletions, and other routine changes?A: Providers can make changes to their application up through submission. However, once submitted, updates can only be made when the application is either returned or approved.
Q: When checking the status of my application, what are the different status definitions?A: The status(s) are as listed below:
- Partial/Started - Application has been started but not yet been submitted or a revalidation has been generated and requires the provider to complete the revalidation
- Awaiting Attachments - Application has been submitted but is waiting for required attachments/documents
- Submitted - Application is complete and has been submitted for review
- Pending - Application has been queued for the enrollment team for review
- RTP (Returned to Provider) - Application requires corrections. (Applicant will receive a separate notification identifying the specific issue(s) requiring attention.)
- Approved - Application has been approved. (Applicant will receive written confirmation that the application has been approved. For newly enrolling Providers, the Welcome Packet includes the Provider number and other program participation information.)
- Expired - Application was not submitted within the allowable timeframe. A new application is required in this situation
- Submitted to Managed Care - Application has been forwarded to MCOs for contracting. (This status is used for KMAP-approved applications that have also requested to participate with additional MCOs.)
Q: I received a notification that my Provider Enrollment application is being returned to me for corrections. What are my next steps?A: From the KMAP Public Portal Home Page, Click the Provider Enrollment Tile to access the Welcome Page. Next, Click Resume/Revalidate. Enter the Tracking Number and Password. Make the appropriate updates in the application. Remember to Save and Continue as you navigate through the pages. Sign the Agreement and submit again. If you received this notice for a new enrollment, you have 60 days from the notice date to resubmit the application with corrections. After 60 days, the Tracking Number expires, and you will no longer be able to resume. If you received this notice for a revalidation, you must submit the corrected application no less than 5 business days prior to your revalidation due date or risk termination.
Q: If a provider is already contracted with the Kansas Medical Assistance Program (KMAP) and a Managed Care Organization (MCO), are they required to recredential/revalidate?
A: All Fee-for-Service (FFS) and MCO enrollments must recredential/revalidate every three (3) years.
Q: How do I determine when my revalidation is due?
A: When you are due to revalidate, you will receive two email notifications letting you know when you are due for revalidation. One email contains an Application Tracking Number (ATN) and the other email contains a 14-digit password. A mandatory password change is required to start the revalidation process.
Q: When will we start getting notifications for revalidations?
A: Revalidation notices will be sent 60 days prior to the due date. A second reminder is sent 30 days prior to the due date.
Q: How do I start my revalidation?
A: Access the Resume/Revalidate Enrollment page of the Provider Enrollment Wizard. The link can also be located on the email notification you received.
Q: I have more than one service location. Do I revalidate all my locations at the same time?
A: Not necessarily. Each service location will be required to revalidate three (3) years from the date of enrollment or the last revalidation date. Be sure to pay attention to which location you are revalidating.
Q: There are several fields on my Revalidation Application that are Grayed out not allowing me to make modifications. What should I do now?
A: There are certain aspects of the enrollment that cannot be changed. If you need to change information on the fields that are greyed out, contact Provider Enrollment.
Q: Will I be termed for not revalidating?
A: Yes, you will be inactivated on the date stated on the letter sent prior to your revalidation due date. Once the revalidation is complete, and if all enrollment requirements are met, you will be reinstated with no lapse in enrollment.
Q: I was inactivated due to not revalidating. How do I become active again?
A: If you were inactivated for No Revalidation, you have 30 days from the revalidation due date to access the Resume/Revalidation page of the Provider Enrollment Wizard and complete your revalidation. If you are inactivated 30 days after the due date, you will need to start a new application in the Provider Enrollment Wizard. Both links are available on the Home and Provider Enrollment Applications pages of the KMAP Public Portal.
Q: Can I bill for services during the time the provider number is inactive?
A: If you are inactivated, you will have the opportunity to back date your application or revalidation up to 12 months to maintain continuity of enrollment. Once approved, you will be eligible to submit claims for the time when you were inactive.
While your enrollment status is inactive, you will not be able to bill KMAP, use AuthentiCare, or verify eligibility for Medicaid-enrolled members
Q: What is TPL?A: Third Party Liability (TPL) is other health care insurance carried by the member. The other insurance can be a commercial policy or Medicare.
Q: How do I report new or updated TPL policy information?A: Commercial policy information can be reported in several ways:
- Fax a copy of the Beneficiary TPL Insurance Information Update form to 785-274-5918 (The Beneficiary TPL Insurance Update form can be found under the Forms section of Provider Publications on the Kansas Medical Assistance Program (KMAP) Public Portal.)
- Call KMAP Customer Service
Note: The following information is required to add or update a TPL policy:
- Member Medicaid ID and Name
To report Medicare updates, please send via secure email to
ksxix-buyin@gainwelltechnologies.comNote: Please include the following information in the email:
- Member Medicaid ID and Name
- Medicare ID Number, if available
- Medicare Part needing updated (A, B, C, D)
Q: How do I reset my Kansas Medical Assistance Program (KMAP) application password?A: On the KMAP Provider Enrollment page, hover over the Provider Enrollment title, then select Manage Password. You will need to know the application tracking number as well as the existing password.
If you do not know the existing password, select the Forgot Password? link at the bottom of the page. A one-time passcode will be sent to the email address associated with the application.
Q: Can I update my email address in the provider secure portal?A: Yes. Most demographic information such as email address, can be updated via the KMAP Provider Secure Portal using the Manage My Information option.
Q: If my information has changed and is not current with KMAP, am I expected to update this information?A: Yes. You are required to notify KMAP of any changes as soon as possible to ensure information is up to date. If you are also enrolled with a Managed Care Organization (MCO), the updates will be shared with the MCOs.
Q: How do I update my National Provider Identifier (NPI) with KMAP?A: Changes to your NPI can be completed in the KMAP Provider Secure Portal or a request can be faxed or emailed. If it is a correction to what is already on file, indicate that on the form. A note such as "Correction to NPI Information" alerts the Provider Enrollment team to the change, rather than potentially causing them to think it is a duplicate update.
Q: I lost my Medical Card; how do I get a new one?A: If you are assigned to Healthy Blue, Aetna Better Health, Sunflower Health Plan or United Healthcare Community Plan – Kansas, contact your KanCare plan for a replacement card. If you are not assigned to a KanCare plan, call Kansas Medical Assistance Program (KMAP) Customer Service. If you have a member online account, you may request a card in the Member Portal. Select ‘ID Card’ from the Requests Menu to submit a request for a new card.
Q: We just got approved for coverage, but I did not receive a State of Kansas Medical Card for all my family members. Why? A: You will not get a State of Kansas Medical Card if:
- You are assigned to a KanCare plan (Healthy Blue, Aetna Better Health, Sunflower Health Plan or United Healthcare Community Plan - Kansas).
- You received a State of Kansas Medical Card within the past 12 months.
- You have coverage under certain programs. There is more information listed in the Member Booklet found under Member Publications on the Member home page of the KMAP Public Portal.
If you should receive State of Kansas Medical Cards, up to four (4) Medical Cards will be mailed per envelope. If you have more than four (4) family members with coverage, you should expect another envelope with the other cards. If you do not receive another envelope within a few days and have not had coverage in the past year, contact KMAP Customer Service.
Three Column Table | Agency | Telephone | Website |
KMAP Customer Service/ROSIE
If you are not assigned to a KanCare plan and have questions about:
| 1-800-766-9012
TDD/TTY: 1-800-766-3777
Business hours:
Monday – Friday
7:30 AM – 5:30 PM | https://portal.kmap-state-ks.us/PublicPage/Public/Login
Log on and password required.
|
Aetna Better Health of Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-855-221-5656
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.aetnabetterhealth.com/kansas
|
Sunflower Health Plan
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-644-4623
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.sunflowerhealthplan.com
|
United Healthcare Community Plan - Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-542-9238
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.uhccommunityplan.com
|
Healthy Blue
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-833-838-2593
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.choosehealthyblue.com/ks/
|
Q: What is Third-Party Liability (TPL) or Other Health Insurance?A: TPL/Other Health Insurance refers to medical/health coverage a member may have in addition to their State of Kansas or KanCare Medical Card benefits. This coverage may be provided by:
- A court-order for health coverage
Q: Why is TPL/Other Health Insurance Important?A: TPL/Other Health Insurance is important because it must be billed before Medicaid/KanCare will consider payment.
Q: What should I do if I have Other Health Insurance?A: Members with Other Health Insurance should:
- Add or report changes to the Other Health Insurance already on file by calling Kansas Medical Assistance Program (KMAP) Customer Service
- Present their State of Kansas or KanCare plan card, as well as their Other Health Insurance card, at appointments and services
- Follow the rules of the health plan, such as using medical providers that have been approved by the plan
Q: Can I report Other Health Insurance online with KMAP?A: Yes, if you have an online account with KMAP, reporting Other Health Insurance can be done by logging into the Member Portal. Select ‘Other Insurance’ from the Benefits menu, then select a Member from the dropdown list. If Other Health Insurance exists for the member, it will be displayed. Double click a row to open the Other Health Insurance information to update it or click ‘Add Policy’ to submit new Other Health Insurance information.
For assistance, please use the
Member Portal User Guide located under the
Shortcuts & Training Materials on the Member home page of the KMAP Public Portal..
Three Column Table | Agency | Telephone | Website |
KMAP Customer Service/ROSIE
If you are not assigned to a KanCare plan and have questions about:
| 1-800-766-9012
TDD/TYY: 1-800-766-3777
Business hours:
Monday – Friday
7:30 AM – 5:30 PM | https://portal-uatc-state-ks.us/PublicPage/Public/Login
Log on and password required.
|
Q: I have been told that I do not have eligibility for coverage right now. Why not?A: You can call the KanCare Clearinghouse to:
- Check on a pending application
- Check the status of a renewal
- Ask about back dated coverage
- Find out why coverage has changed or ended
Q: I may need help with medical bills. Do I qualify for any coverage?A: If you do not have medical coverage on the date of service, please contact the KanCare Clearinghouse to see if you are eligible for benefits.
If you have coverage for the date of service and are assigned to a KanCare plan, contact your KanCare plan.
If you have coverage for the date of service but are not assigned to a KanCare plan, call the Kansas Medical Assistance Program (KMAP) Customer Service.
Q: Who do I call with questions about eligibility?A: The KanCare Clearinghouse.
Q: How do I prove eligibility to the IRS?A: Information about the Form 1095-B can be found under
Q&A about IRS Form 1095-B, located under
Shortcuts & Training Materials on the Member home page of the KMAP Public Portal.
Three Column Table | Agency | Telephone | Website |
KMAP Customer Service/ROSIE
If you are not assigned to a KanCare plan and have questions about:
| 1-800-766-9012
TDD/TTY: 1-800-766-3777
Business hours:
Monday – Friday
7:30 AM – 5:30 PM | https://portal.kmap-state-ks.us/PublicPage/Public/Login
Log on and password required.
|
Aetna Better Health of Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-855-221-5656
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.aetnabetterhealth.com/kansas
|
Sunflower Health Plan
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-644-4623
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.sunflowerhealthplan.com
|
United Healthcare Community Plan - Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-542-9238
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.uhccommunityplan.com
|
Healthy Blue
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-833-838-2593
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.choosehealthyblue.com/ks/
|
Q: Am I currently covered by a medical program?A: You can check your coverage by using the following options:
- Online Account: Register or login to the Kansas Medical Assistance Program (KMAP) Member Portal at https://portal.kmap-state-ks.us/PublicPage/Public/Login. Choose ‘Coverage’ from the Benefits menu. Coverage information will be displayed for the current month for the first member. Select from the dropdown lists and click ‘Submit’ to view coverage for a different member or month/year.
- By Phone: If you have set up an account you can use ROSIE, the automated attendant, by calling KMAP Customer Service and following the prompts or you can choose the option to go to an agent.
Q: Is this service covered?A: To verify if a service is covered, contact your doctor to get the procedure code and diagnosis code. Next, call the number on your KanCare plan card or State of Kansas Medical Card and give them the information from your doctor. They will check and tell you if the service is covered.
Q: Is my medication covered?A: To verify if a medication is covered, call your pharmacy to get the National Drug Code (NDC). Next, call the number on your KanCare plan card or State of Kansas Medical Card and give them the information from your pharmacy. They will check and tell you if the medication is covered.
Q: Why do I not have coverage? A: You can call the KanCare Clearinghouse to:
- Check on a pending application
- Check the status of a renewal
- Ask about back dated coverage
- Find out why coverage has changed or ended
Q: I have a KanCare plan assignment. What does that mean?A: The KanCare plan is responsible for your health care services. When you are assigned to a KanCare plan (Healthy Blue, Aetna Better Health, Sunflower Health Plan or United Healthcare Community Plan – Kansas), you will get the following in the mail:
- Enrollment packet: This packet comes from KMAP and explains your assigned KanCare plan and options. You will have 90 days after approval to ask for a different plan. To change your plan, call the Enrollment Center, return the Enrollment Form, or login to the Member Portal.
- Welcome packet: This packet comes from your KanCare plan and will include your medical ID card and provider/benefit information. Your plan will assign you to a primary care provider (PCP). If you want to change your PCP, call your KanCare plan.
Q: What is a Spenddown?A: Spenddown is like an insurance deductible, where you must incur medical expenses before you qualify for full medical benefits.
Q: I am on Lock-In. What does that mean? A: A member is placed on Lock-In status when they have mis-used their Kansas Medicaid benefits. When you are on Lock-In, you are assigned to one specific provider for your services. You may be locked into a medical provider, a pharmacy, a hospital, or other specialists. If you go to other providers while on Lock-In, you might have to pay the bill. You will be on Lock-In for at least two years.
You can be placed on Lock-In if you:
- Allow another person to use your medical card
- Go to the emergency room when there is no medical emergency
- Use several medical providers to obtain the same kind of drug
- Trade your Medicaid number for money or other things
Q: What does it mean to have a Living Arrangement/Level of Care?A: These special codes show that you have been approved for long term care services. To qualify for long term care, you must have a medical need. Because specialized care is needed for some conditions and because services are offered in a variety of settings, it is important that your record show the type of care you are eligible to get. Only people with these special codes are eligible for payment of long-term care expenses. If you have an online account, your living arrangements/level of care are available in your Coverage & Benefits page. Click on ‘Coverage’ from the Benefits menu.
Q: What is KAN Be Healthy? A: KAN Be Healthy (KBH) is a program for children and designed to:
- Prevent illness with regular check-ups and immunization shots
- Find health problems early by seeing a medical provider on a regular basis. Finding a health problem early makes it easier to treat
- Use several medical providers to obtain the same kind of drug
More information about KBH can be found under
Wellness located on the Member page of the KMAP Public Portal.
Q: Who is eligible for the KAN Be Healthy program?A: Children from birth through age 20 who receive Medicaid.
Q: What services are covered by KAN Be Healthy? A: KAN Be Healthy coverage includes:
- Some over-the-counter medicines (a prescription is needed; check with a pharmacist for more information)
- Rides to a medical provider
- Diet and nutrition appointments
Q: What if I cannot show up for my doctor’s appointment?A: Call your doctor as soon as you know you will not be able to make the appointment (at least 24 hours in advance, if possible).
Q: When should I go to the emergency room?A: You should go to the emergency room when you believe you have a true emergency. If you believe there is a true emergency, you do not need to call your doctor before you go to the emergency room. A true emergency is a problem that is life threatening or may cause you to lose your arm, leg, or any other part of your body.
Q: I think I am pregnant. What do I do?A: Your medical card will pay for medically necessary pregnancy care. Schedule an appointment to begin prenatal care. Contact the KanCare Clearinghouse to report your pregnancy.
Q: When should I report the birth of my baby?A: As soon as you have your baby, call the KanCare Clearinghouse to request coverage. A medical card will be issued in your baby’s name once they have been added to your case. If you do not receive their card, call your KanCare plan, or KMAP Customer Service if you are not assigned to a KanCare plan.
Q: Are vision services covered?A: Coverage for vision services depends on the program you have. If you are assigned to a KanCare plan, call your KanCare plan. If you are not assigned to a KanCare plan, call KMAP Customer Service.
Q: Can I get a ride to medical services?A: There is coverage for Nonemergent Medical Transportation (NEMT) services depending on your plan. Rides are only covered if you are going to a Medicaid/KMAP covered service and you follow the rules of your plan. If you are assigned to a KanCare plan, call your KanCare plan. If you are not assigned to a KanCare plan, call KMAP Customer Service.
Q: What if I am not happy with services?A: If you are assigned to a KanCare plan, call your KanCare plan. If you are not assigned to a KanCare plan, call KMAP Customer Service.
Three Column Table | Agency | Telephone | Website |
KMAP Customer Service/ROSIE
If you are not assigned to a KanCare plan and have questions about:
| 1-800-766-9012
TDD/TTY: 1-800-766-3777
Business hours:
Monday – Friday
7:30 AM – 5:30 PM | https://portal.kmap-state-ks.us/PublicPage/Public/Login
Log on and password required.
|
Enrollment Center
To request changes to your KanCare health plan.
| 1-866-305-5147
TDD/TTY: 1-800-766-3777
Business hours:
Monday – Friday
7:30 AM – 5:30 PM | https://portal.kmap-state-ks.us/PublicPage/Public/Login
Log on and password required.
|
KanCare Clearinghouse
To apply for Kansas Medicaid. Or to:
- Check on a pending application or renewal
- Report changes (address, phone, family size)
- Find out why coverage has changed or ended
| 1-800-792-4884
Business hours:
Monday – Friday
8:00 AM – 5:00 PM | http://www.kancare.ks.gov/ Write: PO Box 3599
Topeka, Kansas 66601
|
Aetna Better Health of Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-855-221-5656
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.aetnabetterhealth.com/kansas
|
Sunflower Health Plan
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-644-4623
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.sunflowerhealthplan.com
|
United Healthcare Community Plan - Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-542-9238
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.uhccommunityplan.com
|
Healthy Blue
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-833-838-2593
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.choosehealthyblue.com/ks/
|
Q: Can I use my smartphone or tablet to access the Kansas Medical Assistance Program (KMAP) Portal?A: Yes. If you are using a tablet or smartphone, KMAP Portal supports landscape mode only using Chrome (Android) and Safari (iOS).
The KMAP Portal can be accessed by most of the web browsers. For the best performance use Google Chrome, Microsoft Edge, or Mozilla Firefox
Q: I forgot my KMAP password, can I still login?A: Yes, there is a
‘forgot password’ option after you enter your username on the Member Portal. It will walk you through resetting your password. If you need further assistance with this, please contact KMAP Customer Service.
Q: I forgot my username, can I still login?A: No, contact KMAP Customer Service.
Q: I'm having problems registering on the KMAP Member Portal, how do I register?A: If you still have your registration letter, follow the steps in the letter. If you do not have the letter, contact KMAP Customer Service. They will assist you with the process.
A: A
Member registration guide is also available under Registration Instructions, located on the KMMS Login page of the KMAP Public Portal.
Q: The KMAP Member Portal requires that I have an email account, but I don't have one. How do I get an email account?A: If you do not have a personal email address, you can set one up as early as today. There are many different companies that offer free email services. You can search on the Internet for these companies by using the phrase ‘free email service’. Once you have chosen a company, it only takes a few minutes to set up an email address.
Q: What if I need help using the KMAP Portal or I don't understand the information on the screen?A: A
Member Portal User Guide is available under
Shortcuts & Training Materials, located on the Member page of the KMAP Public Portal, to assist you with using the Member Portal.
Q: I have trouble reading the small print, can you help me see the information better?A: You can adjust the text size by using the zoom control in your web browser or you can press
Ctrl and
+ to zoom in and
Ctrl and
- to zoom out.
For the best performance use Google Chrome, Microsoft Edge, or Mozilla Firefox.
Three Column Table | Agency | Telephone | Website |
KMAP Customer Service/ROSIE
If you are not assigned to a KanCare plan and have questions about:
| 1-800-766-9012
TDD/TYY: 1-800-766-3777
Business hours:
Monday – Friday
7:30 AM – 5:30 PM | https://portal-uatc-state-ks.us/PublicPage/Public/Login
Log on and password required.
|
Q: Who do I talk to if I want to apply for Medicaid?A: To apply for Medicaid, call the KanCare Clearinghouse.
Q: Who do I contact with questions about coverage?A: If you are assigned to a KanCare plan, you can contact your KanCare plan.
If you are not assigned to a KanCare plan, you can contact the Kansas Medical Assistance Program (KMAP) Customer Service..
Q: What doctors can I see?A: You may search for providers using the
Provider Directory on the KMAP Portal and indicate what health plan you have. Or, .
If you are assigned to a KanCare plan, you can contact your KanCare plan.
If you are not assigned to a KanCare plan, you can contact KMAP Customer Service.
Three Column Table | Agency | Telephone | Website |
KMAP Customer Service/ROSIE
If you are not assigned to a KanCare plan and have questions about:
| 1-800-766-9012
TDD/TTY: 1-800-766-3777
Business hours:
Monday – Friday
7:30 AM – 5:30 PM | https://portal.kmap-state-ks.us/PublicPage/Public/Login
Log on and password required.
|
Enrollment Center
To request changes to your KanCare health plan.
| 1-866-305-5147
TDD/TTY: 1-800-766-3777
Business hours:
Monday – Friday
7:30 AM – 5:30 PM | https://portal.kmap-state-ks.us/PublicPage/Public/Login
Log on and password required.
|
KanCare Clearinghouse
To apply for Kansas Medicaid. Or to:
- Check on a pending application or renewal
- Report changes (address, phone, family size)
- Find out why coverage has changed or ended
| 1-800-792-4884
Business hours:
Monday – Friday
8:00 AM – 5:00 PM | http://www.kancare.ks.gov/ Write: PO Box 3599
Topeka, Kansas 66601
|
Aetna Better Health of Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-855-221-5656
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.aetnabetterhealth.com/kansas
|
Sunflower Health Plan
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-644-4623
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.sunflowerhealthplan.com
|
United Healthcare Community Plan - Kansas
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-877-542-9238
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.uhccommunityplan.com
|
Healthy Blue
To pick a doctor or ask questions about your health care benefits, including transportation.
| 1-833-838-2593
Business hours:
Monday – Friday
8:00 AM – 6:00 PM | www.choosehealthyblue.com/ks/
|
Q: Where can I find more information about KanCare?A: For more information about KanCare, contact the KanCare Clearinghouse by phone or online.
Three Column Table | Agency | Telephone | Website |
|
KanCare Clearinghouse
To apply for Kansas Medicaid. Or to:
- Check on a pending application or renewal
- Report changes (address, phone, family size)
- Find out why coverage has changed or ended
| 1-800-792-4884
Business hours:
Monday – Friday
8:00 AM – 5:00 PM | http://www.kancare.ks.gov/ Write: PO Box 3599
Topeka, Kansas 66601
|
