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KanCare All MCO Training Policy
Fall 2020
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Welcome, Introductions &
Agenda
• Welcome
• Introductions
– Aetna Better Health of Kansas
– Sunflower Health Plan
– United HealthCare
• Agenda for the day– KDHE / KDADS POLICY
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KDHE Policy
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Mom and Baby claims
Section 7010 of the Professional Billing Manual
• Only procedure codes which specifically state “newborn”
• Newborn without Medicaid Id
– First name – “Newborn”, “Baby Girl”, or “Baby Boy”
– Last name – babies last name
– Newborns date of birth
– Mom’s beneficiary ID number
– Claim will suspend for 30 days – if newborn’s ID number is
received claim will deny notifying provider to submit a new
claim
with baby’s ID.
– Claim will pay under mom’s ID number, if baby doesn’t have
an
ID. Dates of Service is within 45 days of baby’s date of birth,
if
billed according to the above.
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Recent Policy Changes
Policy Changes
• KMAP General Bulletin 20109 – Effective July 1, 2020
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Recent Policy Changes
Policy Changes
• KMAP General Bulletin 20115
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OneCare Kansas
6https://kancare.ks.gov/providers/onecare-ks-providers
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OneCare Kansas
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https://kancare.ks.gov/providers/onecare-ks-providers
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KMAP Provider Enrollment
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Provider Update – Demographic Updates must be submitted to
KMAP on the following form.
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KMAP Provider Enrollment
https://www.kmap-state-
ks.us/Documents/Content/Forms/Provider%20Update%20Form.pdf
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Recent Policy Changes
Policy Changes - KMAP General Bulletin 20098 –
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Recent Policy Changes
• KMAP General Bulletin 20098 – continued
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Recent Policy Changes
• Bulletin 20098 – continued
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Recent Policy Changes
• Bulletin 20098 – continued
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Recent Policy Changes
• Bulletin 20098 – continued
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Recent Policy Changes
• Bulletin 20098 – continued
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KMAP Provider Enrollment
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Some key information for enrollment
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KMAP Provider Enrollment
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KMAP Provider Enrollment
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Select the appropriate option
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KMAP Provider Enrollment
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https://portal.kmap-state-ks.us/ProviderEnrollment/EnrollmentCreate
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KMAP Provider Enrollment
https://www.kmap-state-
ks.us/Public/forms.asp
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Some of these forms might need to be attached
with application. KMAP Provider Forms
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KMAP Provider Enrollment/MCO
Credentialing/MCO Contracting
• There are still 3 steps to finalize credentialing/contracting
with the MCO
❖ Submit application through the Portal
a) Enrolls provider with KMAP or
b) Revalidates with KMAP
c) Provider selects MCO(s) they want their information
shared
with
❖ KMAP provider enrollment shared with selected MCOs
❖ Credentialing - MCO receives the paperwork from the Portal,
this
packet is used for credentialing purposes.
❖ Contracting –. It may be required for providers to submit
additional
documents to complete their contracting with the MCO’s.
Providers will have to sign and return the contract to the
complete
the contracting with the MCO.
*Please note some of the steps may not be required if provider
is
already credentialed or contracted with the MCO21
The KMAP Provider Portal helps mainstream the application
process, one application
which is sent to the MCO(s) that the provider selects within the
Portal.
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Questions?
