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.

No, you are responsible for obtaining authorization (if the health plan requires it for the service) and billing the member's KanCare MCO.

You must file your grievance or appeal with the MCO involved. Each MCO has established processes that must meet federal regulations. The process will be described in their contract or provider manual.

The contract with the MCOs and Kansas regulations require payment of all “clean claims” within 30 days. If you have repeated issues, providers are encouraged to reference the Provider Escalation Guide on the KMAP site.

A clean claim means it can be processed without obtaining additional information from the provider on the service or from a third party.

Yes, you can; however, as a fee-for-service provider, the services you provide may be limited to a very small Medicaid population or be considered “out-of-network” by the managed care organizations (MCOs).

If you do not sign a contract with the MCO you could enroll to be a fee-for-service provider.

Yes, a small number of Medicaid consumers were excluded from KanCare. See the Beneficiaries Excluded from KanCare list for details.

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.

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 outlined in the FAQ Maternity Care Split Billing.

No, all three must use the State definition outlined in Attachment C of the KanCare Request for Proposal, which is incorporated by reference into the contract with each health plan.

No, the prior authorization requirements are not mandated, but the State requires each MCO to have transparent requirements.

No, the State will maintain the PDL.

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

Yes, the health plans have committees with provider representatives. Providers are also represented on the Governor’s KanCare Advisory Council.

If you have questions about the KanCare program, we want you to get the information you need. See this Contact List or visit the Provider Escalation Guide on the KMAP site. 

In the event you have encountered an issue, please reference the Provider Escalation Guide on the KMAP site. The points of contact should be contacted in the order listed within each section.