Effective October 25, 2021, three new documents will be required based on provider type/specialty (PT/PS) for providers when enrolling with any KanCare Managed Care Organization (MCO).
1. Section 12 Attestation/Consent and Release Form
This form will be required for all provider types (PT) and provider specialties (PS) when enrolling with any KanCare MCO and will be required when credentialing providers.
2. Kansas Org Provider Cred/Recred Application
Commonly referred to as the “Joint Credentialing Application,” completion of this form will be required for the following PT/PS before credentialing with any KanCare MCO:
3. HCBS Supplemental Form
This form will be required for the following PT/PS before credentialing with any KanCare MCO:
The form should be completed for each service the provider offers. For each waiver service being performed the provider must indicate which county they will provide services and include the number of members they are able to see. More detailed instructions are on the form.
All forms are located on the Kansas Medical Assistance Program (KMAP) website. Providers may download and complete forms here. For questions completing any of the forms, please contact the applicable MCO.
Note: The effective date of the policy is October 25, 2021. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.