Kansas Medicaid Provider Agreement

Like Aetna Better Health of Kansas Provider, there are certain procedures and protocols you need to know. You will find most of the information in the supplier`s guide. You will know what services are covered for our members. You will also find information on a wide range of topics, from filing a complaint to complaints and complaints. The supplier guide is an essential resource for all our suppliers. You can print a copy to keep it convenient, or mark that page on your computer with a bookmark. If you would like a copy of the supplier`s guide to be sent to you within five (5) business days, you can request it for free by contacting your supplier experience representative or by calling 1-855-221-5656 (TTY: 711). Blood Lead Screening Questionnaires Developmental Scales (Birth to 4 years) Hearing Health History (5 years and up) KBH – EPSDT Screening KDHE Requisition for Laboratory Specimen Kits and supplies Risk Indicators for Hearing Loss Checklist (Birth to 4 years) Compliance certificate with Section 6032 of the Federal Deficit Act Re behavi Interventionoral Atte Post collaborating Clinician Statement Disclosure Property and Control of Interest Statement Drivers Certificate EDI – Electronic Claims Deposit Request EDI Updates Supplemental Form KANCARE PBM Combined Pharmacy Credentialing Form NEMT Provider NPI-Information as applicable form National ID ID Identifying Update Provider Premium Payment Assistance Provider TPL Insurance Update Supplier Request for Medicaid Hearing (Provider) Screening, Short Intervention, and Referral to The Treatment Establishment Certificate Destination Insurance Payment Premium Assistance Beneficiary TPL Insurance Information Update Request for Medicaid Hearing (beneficiaries) Home/Discharge Facility Notice (MS-2126) Certificate of Medical Necessity Hard Copy Attachment Cover Sheet Custom Adjustment Request Medical Examination of Emergency Services for SOBRA (MS-2156) Medicare Unaffected Question Multiple Adjustment Request NDC Detail Attachment TPL CARC – RARC Certification by Medical Providers for Transportation Services For Commercial Services NEM Medical Transport Necessity NEMT Transport Bones Anchored Integrated Hearing Devices Explanation of Need for Hearing Prostheses Prior Authorization General Request Hyperbaric Oxygen Therapy Prior Authorization Hyperbaric Oxygen Therapy Prior Authorization Hyperbaric Organisation – Renewal Certificate of Medical Necessity – CMS-484 – Oxygen Enteral Nutrition Prior Authorization Prior Authorization Application On Demand Negative Pressure Wound Therapy Prior Request Negative Pressure On The Wound Extension Prior Authorization Prior Wheelchair Request Prior Authorization Doctor Request Order Form/Medical Necessity for Diabetes Tests Delivered Pulse Oximeter Application for Special Seat Application Request Total Parenteral Nutrition Prior Authorization Authorization Prior Authorization Request HCBS/FE Adult Day Care Log HCBS/FE Assistants Technology Receipt HCBS/FE Comprehensive Support and Personal Care Services Log HCBS/FE Compre Log HCBS/FE FE Personnel Care Services Log HCBS/FE Personal Care Services Log (Facility) HCBS/FE Personal Care Services Services Weekly Care Log HCBS/FE Enhanced Care Services Log HCBS //FE Wellness Monitoring HCBS TBI Kansas Traumatic Brain-Injury Rehabilitation Facility Referral HCBS TBI Program Eligibility NDC Certificate Pricing Inquiries Request for Review – NDC-HCPCS or CPT Crosswalks Abortion Necessity Consent for sterilization – HHS-687 Sterilization Approval – HHS 687-1 Spanish Hysterectomy Need for Acute Care Home Health Service Plan Request Change in Home Health Service Plan or Service Offloading Diabetes Management Home Health Plan Request Long-Term Care Home Health Service Plan Request Primary Health Care Health Care Health Care MEDICAID Home Health Care ADA Dental Claim Form 1500 Claim Pharma Claim Form 1500 Claim Pharmacy UB-04.


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