KanCare: Reinventing Medicaid for Kansas

Providers

Frequently Asked Questions

Notice of Privacy Practices

Who do I call if I have questions?
If you have questions about the KanCare program we want you to get the information you need. See this Contact List for information and phone numbers to call to get your questions answered.

How should providers bill for inpatient stays? What if the payer changes during an inpatient stay?
Providers should bill the payer responsible for a consumer’s care at the point of admission. This payer will be responsible for the entire inpatient stay. For example, if a consumer entered an inpatient facility on December 29 and was discharged on January 2, the provider should bill the payer who was responsible on December 29. However, any ancillary services received after the date of discharge should be billed to the responsible payer on the date of service.

Were any consumers excluded from KanCare? I cannot find a health plan assignment for one of my consumers.
Yes. A small number of Medicaid consumers were excluded from KanCare. See this list of excluded beneficiaries for details.

What if I don’t sign a contract with a health plan?
If you don’t sign a contract with a specific health plan, you would be considered an “out-of-network” provider. See this Continuity of Care document (updated 1-3-13) for details during the transition to KanCare.

If I don’t sign up with any health plan, can I still be a Medicaid provider?
Yes, you can; however, the services you provide may be limited to a very small Medicaid population or be considered “out-of-network” by the health plans.

Do all the plans have to contract with me?
The State requires each health plan to offer contracts to all existing Medicaid providers.

What if the health plan doesn’t pay my claim quickly?
The contract with the health plan requires payment of all “clean claims” within 30 days.  There is also a performance incentive payment for paying claims more quickly.

What is a “clean claim”?
A clean claim means one that can be processed without obtaining additional information from the provider of the service or from a third party.

If a claim is denied by a health plan, can I bill fee-for-service Medicaid?
No.  You are responsible for obtaining authorization (if the health plan requires it for the service) and billing the KanCare health plan the member is enrolled in.

What if a health plan wants to pay me less than I was paid in the fee for service program?
The health plan must pay you at least the fee for service rate in effect November 9, 2012.

Will all three health plans have the same prior authorization requirements?
Each may have different requirements, but the State is requiring them to have transparent requirements so that providers will easily know what the requirements are.

Will each health plan have different medical necessity requirements?
All three must use the State definition outlined in Attachment C of the KanCare RFP, which is incorporated by reference into the contract with each health plan.

Will providers who submit in-home service claims through Authenticare continue to do so?
Yes.  Providers will work with Authenticare.

I provide services to someone who self-directs.  What changes for me?
You will continue to work with an FMS agency and report your hours through Authenticare.

Will each health plan have its own preferred drug list (PDL)?
No.  The State will maintain the PDL.

Are the health plans incentivizing mail order pharmacy?
No, although they may offer it as an option for members.

What are providers’ options to file a grievance or appeal?
You must file your grievance or appeal with the health plan involved.  Each of them has established processes that must meet federal regulations and will be described in their contract with you or their provider manual.

Will providers have any input into how KanCare operates?
Yes.  The health plans have committees that will have provider representatives.  Providers are also represented on the Governor’s KanCare Advisory Council.  There are four external workgroups that will help the State implement KanCare; providers are represented on each of those workgroups.

Will I submit claims to the three health plans or continue to submit them to the State’s MMIS?
The State will maintain a single, front-door billing interface where providers can submit claims.  You can also submit claims to each health plan directly, or use an established commercial clearinghouse.

Can providers still contact the State for help or to ask questions?
Yes, providers can contact Provider Assistance at 1-800-933-6593, or by email at KanCare@kdheks.gov


How do I bill when maternity care spans over multiple MCOs?
Providers can use as a reference the KMAP professional manual section 8400 pg 8-21. In instances when a patient’s pregnancy is not covered by a single MCO, the provider will split bill previous/current MCO in accordance with the guidelines in this document.


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