Drive performance and improve quality of care for kansas medicaid. Please note that this manual only includes adult bh hcbs available to eligible individuals in health and recovery plans harp or. The type of coverage you have will determine how you receive coverage. The primary care physicians and interdisciplinary team of professionals provide and coordinate all services for you, providing a one stop shopping for your needs. Kmap uses the provider manual 2015 direct contract easy choice health plan. The kansas medical assistance program kmap offers different billing options to all providers. The primary care physicians and interdisciplinary team of professionals provide and coordinate all services for the individual, providing a onestop shop for the individuals needs. Participation with hfni contracted health plans by following the procedures outlined in this provider manual and any contracted health plan provider manual, your participation will be in compliance with your contractual obligations. Providers must respond to communications from provider enrollment immediately and no later than february 23, 2018, to complete the corrections. All network providers must be kmap enrolled and screened prior to receiving payment from an mco. This chapter does not address all the complexities of medicaid policies and procedures, and must be. Map and contact information resources medicaid autism bhtaba services. Survey of states providing coverage for inhome telemonitoring. For the changes resulting from this provider bulletin, view the updated professional feeforservice provider manual, section 8400, pages 831 and 832.
Both current and discontinued manuals have historical versions available. If i missed a provider seminar, can i still receive education. Kansas medical assistance program provider manual kmap home. February 2015 interested in participating in the amerigroup kansas, inc. Refer to chapter 2, from denial of application to permanent exclusion.
Molina healthcare updates and publishes the provider manual once a year. Responsibilities section of our provider manual and endure your staf is. Since the early 1990s, the importance of knowledge management km and innovation management im to create an organizations competitive advantage has been widely recognized worldwide in the government, public and private sectors. Kmap login opens the door for many health benefit schemes what is kmap login. Services are costeffective, integrated, coordinated, flexible, evidencebased, and. Oct 8, 2015 currently, 16 state medicaid programs cover telemonitoring services, which is an in 20, the commonwealth fund published its findings from includes a onetime fee that covers the cost of. One can access to the website initially using a pin or personal identification number or with the help of a user id and password. Health care finance,pharmacy,drug,kmap web site,medicaid, kdhe home,adjustment request form,medicaid drug rebate. We are pleased to offer this manual as a communication tool and a reference guide for our program providers and their office staff. Fqhc and rhc facilities must enroll as a facility type provider. Kings mountain associated parents kmap is an allvolunteer nonprofit organization that coordinates the parentled groups at kings mountain elementary school kmes to maintain longterm success for this awardwinning california distinguished school and its students. Ikmap 2014 910 october 2014 bangkok, thailand competitive advantage through knowledge and innovation. Complete, line byline instructions for completion of the cms1500 are available in section 5800 of the.
Login beneficiary kmap login opens the door for many. Kspec0320 issued december 20 by amerigroup kansas pcp rate increase provider update background. This is an amendment to your existing provider manual. Public pages include general updates and useful information. Upon completion of the contracting and credentialing process, you will be notified of your contract effective date and will receive a provider welcome packet.
Sunflower provider office manual sunflower health plan. Websites our industryleading provider website includes both public and secure pages. The kancare health plans must pay at least 100 percent of the current feeforservice medicaid rate as of 11912 to all contracted, inplan providers. Claims can be submitted on the kmap secure website, through provider electronic solutions pes, or on paper. Due to the health plan regulations, enrollment with kmap, is required as well. Interim billing and financial worksheet kansas samhsahrsa. All forms pertaining to this provider manual can be found on the public website. Updated 0808 filing proof of eligibility when a claim is denied beneficiary ineligible for dates of service on the remittance advice ra and you have proof of kmap eligibility, attach eligibility documentation, along with.
Michigan medicaid applied behavior analysis services provider directory pdf icon. The legal name and provider federal tax identification number tin must match the information on the w9 for businesses and internal revenue service records for individuals. Please refer to the financial management services kmap. The following health plans or managed care organizations mcos were awarded the contracts to provide kancare services. Provider manual introduction mission statement all washington county health share of oregon ohp and other lowincome residents will have ready access to necessary, high quality behavioral health services appropriate to their level of need. Hcbs mental retardation or other developmental disabilities.
Enter the lockin physicians 10digit kansas medicaid provider number or npi. Optumrx provider manual this manual is regularly updated with general announcements. Home health agency providers must use the cms 1500 paper or equivalent electronic claim form when requesting payment for medical services and supplies provided under kmap. Kansas medical assistance prog provider manual cmhc. Aug 19, 20 kansas medical assistance program provider manual kmap kmap either pays the claim or returns the hipaa remark code 23 or 42 and the eob 0095 on the remittance advice ra stating the claim is paid zero dollars.
For professional claims refer to the kmap general special requirements manual. Coverage of telehealth services in medicaid and medicare. In order for a service to be covered, you must use a kansas medicaid provider. Amerigroup retains the right to add to, delete from and otherwise modify this provider manual. Kmap web site paper billing these options give providers different channels for their specific office needs.
Some licensing requirements for adult care homes apply to adc providers. Kansas family medical assistance manual kfmam eligibility policy 4202020. Assistance program feeforservice provider manual, updated december 2016. To locate a regional provider services representative, call 18888000760. All discontinued manuals no longer contain active information and are strictly available for historical purposes. Providers are required to keep the documentation required for billing each hcbs service as outlined within the kmap hcbs manuals and approved hcbs. The provider name must be the current name on tax, corporation, or other legal documents. Share on linkedin share on facebook share on twitter share. Chapter 5 intellectual and developmental disabilities. Program of allinclusive care for the elderly pace the pace program is designed to promote the provision of quality, comprehensive health services for older adults. Family, guardians or representatives can be a big help in getting the right services, and can use this information to assist in supporting the member. Billing guidelines for providers of idd waiver services. As of november 1, 2018, all providers are required to have a kmap identification id. This provider specific section of the manual part ii is designed to provide information and instructions specific to providers of hcbs fms waiver program services.
If you have completed the application and have not received the pin letter or lost the pin letter, please call the kmap customer service center at 18009336593 between 8. The terms and conditions expressed in your provider agreement with hfn take precedence over information that is included in the provider manual. The kansas department on aging licenses adult day care adc facilities. Welcome to your new home for the latest news, policy information and access to link selfservice tools for care providers. Hospitals which are eligible for ehr incentive payments under both medicare and medicaid when registering with cms, should select both medicare and medicaid during the registration process, even if they plan to apply only for a medicaid ehr incentive payment by adopting, implementing, or upgrading certified ehr technology. Please refer to kmap provider manual for aap recommended developmental tools. Home and community based services hcbs waivers, money follows the person mfp, behavioral health, senior care. Complete, line byline instructions for completion of the ub04 are available in section 7000 of the. The manuals provide policy for the medicaid, kancare chip, medikan and other state medical assistance programs and are used by staff when issuing an eligibility determination for these programs. Kansas lhd clinical services coding resource guide reference codes. If you are enrolled in kancare or providing services to a kancare member, links for the individual plans are under kancare health plans. To better serve the kansas medical assistance program kmap providers during the covid 19 public health emergency, this page contains the latest information regarding the covid 19 changes being implemented by kmap.
Children provider manual, quick reference guides and other helpful forms. The kfmam and medical keesm are two separate manuals and are accessed by selecting the appropriate link. All contracted practitioners providers collectively referred to going forward in this manual as provider or providers will be notified of any additional updates or changes that occur either via the provider newsletter or by letter. Children providers are encouraged to return eft forms as soon as possible to allow adequate time for processing billing codes and limitations please refer to the state provider manual for the waiver service codes that are covered for idd waiver beneficiaries t2020 for day supports will be changing to t2021 effective 11 2014. Kmap web site free fast secure fast response on claim status. Physician groups tied to the fqhc and rhc must enroll as group provider. Chapter 5 intellectual and developmental disabilities waiver iddw effective 1212015 disclaimer. The purpose of this site is to provide a central point for providers to obtain information for area agencies on aging, aging and disability resource centers, community developmental disabilities organizations, centers for independent living, hospitals, assessors, targeted case managers, adult care homes, service providers and others within the aging and disability network.
Kansas covers adc provided by licensed providers through its medicaid 1915c frail elderly waiver program. Plese see the kancare open claims resolution log on the kmap bulletins page for the latest mco system status. We hope you find this information and the enclosed documents useful to your office operation and in serving your patients our members. The provider agrees to furnish records and original. This portal will be available for use on march 12, 2018, and in person training is. Kansas medical assistance program kmap enrollment and contract.
This chapter does not address all the complexities of medicaid policies and procedures, and must be supplemented with all state and federal laws and regulation. In 2014, the florida medicaid program implemented a new system through. This portal will be available for use on march 12, 2018, and in person training is available in february. The home and community based services final rule prohibits providers of 1915 c waiver services and those with an interest in or employed by. If you have not completed an application, please select and complete an application from the provider enrollment applications page that matches your practice or business if you have completed the application and have not received the pin letter or lost the pin letter, please call the kmap customer service center at 18009336593 between 8. Kspec0320 pcp rate increase provider manual update cmap. The provider manual is intended as an administrative guide.
The goals of the provider services department are to educate providers about texanplus and promptly resolve provider issues. If a claim is submitted thru kmap, can the provider be reimbursed through payspan. Contracted providers must acknowledge this provider manual and any other written materials provided by amerigroup as proprietary and confidential. Aetna better health of kansas provider manual approved 041019. The full timeline and transition information are detailed in mco general bulletin 181. Health care finance,pharmacy,drug, kmap web site,medicaid, kdhe home,adjustment request form,medicaid drug rebate. For kansas medical assistance program kmap new and revalidating providers, the state has a new provider portal. Kansas, july 2014 cpt code diagnostic code community health center medicare state medicaid comments t1015 md, pa, anp 99211 99215 est. Secure pages are available only to network providers and require registration. The provider manuals page is divided into two sections. The kmap website provides information to medicaid beneficiaries and providers. Pcps and providers delivering care to sunflower members must ensure members age 18 years and older receive information on advance directives and are informed of their right to execute an advance directive. Please refer to the state provider manual for the waiver service codes that are covered for idd waiver beneficiaries t2020 for day supports will be changing to t2021 effective 11 2014.
Provider manual new york state is pleased to release the adult behavioral health home and community based services bh hcbs manual that will be used as a basis to begin the bh hcbs designation process. This packet will include a copy of the provider manual, the billing manual, quick reference guides and other helpful forms. Outofnetwork providers will receive 90 percent of the current feeforservice rates. Implementing kmap will change the way you manage your business, whether its a whole new area for you or if your migrating from another system. Provider shall not bill, charge, collect a deposit from, seek compensation or reimbursement from, or have any recourse against customers or persons, other than cigna healthspring, acting on behalf of customers for covered services provided pursuant to the participating providers agreement. Chapter 5 intellectual and developmental disabilities waiver iddw bms provider manual page 1 chapter 5 intellectual and developmental disabilities waiver iddw effective 1212015 disclaimer. Apr 14, 2014 hcbs fms feeforservice provider manual.
Each office, hospital, clinic, and ancillary provider will be assigned a dedicated provider network specialist. Effective august 24, 2018, and retroactive to dates of service on and after july 1, 2018, a reimbursement policy change will be implemented so all inpatient and outpatient hospital service payments issued by the kansas medical assistance program kmap will be increased by 4%. See the provider manual for a list of recommendations for providers. Updated 1009 the cms1500 claim form providers of professional services must use the cms1500 red claim form unless submitting electronically when requesting payment for medical services and supplies provided under. Providers can contact kmap provider enrollment at 1800 9336593 with any additional questions regarding physician enrollment. The website of the kansas medical assistance program kmap is intended for medical assistance providers, clerks and clearing houses. General kmap program information can be accessed in the banner links above. Kmap new provider enrollment application wizard training. The manual covers topics such as the product offerings, claims processing and payment, repricing, and credentialing. Providers should use this provider manual in conjunction with the cigna healthspring participating provider agreement to understand important participation requirements such as.
To ensure a broad base of providers, we encourage providers to enroll with each of the kancare plans. The provider enrollment pe wizard replaces the existing online pe application. Updated 0808 filing proof of eligibility when a claim is denied beneficiary ineligible for dates of service on the remittance advice ra and you have proof of kmap eligibility, attach eligibility documentation, along with an. Refer to section 1100 of the general introduc tion provider manual. The community behavioral health provider manual is updated quarterly throughout each state fiscal year and is posted one month prior to the effective date. Gateway to better health provider manual 4 as a basis for determining whether an individual is able to pay the charge, the provider is permitted to accept, in the absence of evidence to the contrary, the participants statement of inability to pay at the time the charge is imposed. Community behavioral health provider manuals from previous fiscal years. Clicking print will open a pdf in a new window containing the content from the options checked above. Thank you for participating in the molina healthcare network of providers. Failure to respond by this date will result in the expiration of the application, and the provider will need to start a new application in the kmap provider enrollment wizard after march 12, 2018. Providers can access publications, interactive tools, and other helpful information. Cpt codes, descriptors, and other data only are 2014 american.
64 892 192 601 1473 365 982 818 900 817 915 874 1314 1416 839 1010 804 638 815 781 1218 1527 1117 1252 636 363 627 1438 1406 67 1216