Frequently Asked Questions

Providers Frequently Asked Questions

• 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 found in FAQ Maternity Care Split Billing.

• Can providers still contact the State for help or to ask questions?

  Yes, providers are encouraged to contact Provider Assistance at 800-933-6593, or by email at KanCare@kdheks.gov.

• Do 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.

• Do 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 work groups that will help the State implement KanCare; providers are represented on each of those work groups.

• What are providers’ options to file a grievance or appeal?

  You must file your grievance or appeal with the MCO 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.

• Are the MCOs incentivizing mail order pharmacy?

  No, although they may offer it as an option for members.

• Does each MCO have its own preferred drug list (PDL)?

  No. The State will maintain the PDL.

• Does each MCO 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.

• Do all three MCOs have the same prior authorization requirements?

  No, each MCO may have different guidelines when it comes to a covered service and if it requires prior authorization. However, the state requires each MCO to have transparent requirements so that can you easily know what requires a prior authorization for rendered services.

• 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 MCO the member is assigned to.

• What is a “clean claim”?

  A clean claim is a submitted claim without any errors or issues, including incomplete documentation that delays timely payment. This means a claim that can be processed without obtaining additional information from the service provider or from a third party.

• What if the health plan doesn’t pay my claim quickly?

  The contract between MCOs and Kansas regulations require payment of all “clean claims” within 30 days. If you have repeated issues, providers are encouraged to speak with the MCO responsible and with KDHE.

• If I don’t sign up with any MCO, can I still be a Medicaid provider?

  Yes, you can; however, the services you provide may be limited to a very small Medicaid population and be considered “out-of-network” by the MCOs.

• What if I don’t sign a contract with one of the MCOs?

  If you don’t sign a contract with a specific health plan, you will be considered an “out-of-network” provider.

• 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 the Beneficiaries Excluded from KanCare list for details. You will need to bill KMAP/Fee For Service for payment for these consumers.

• 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.

• 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.