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 outlined in the FAQ Maternity Care Split Billing.

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

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.

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

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.

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

No. The State will maintain the PDL.

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.

The State requires each MCO to have transparent requirements so that providers will easily know what the requirements are.

No. You are responsible for obtaining authorization (if the health plan requires it for the service) and billing the KanCare MCO the member is enrolled in.

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

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 speak with the MCO responsible and with KDHE.

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 MCOs.

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

Yes. A small number of Medicaid consumers were excluded from KanCare. See this 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.

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.