Welcome to the Online Provider Enrollment System
Thank you for your interest in the Kansas Medical Assistance Program (KMAP). All of the materials within this document must be completed and returned to the fiscal agent for your request to be processed. A checklist of required documentation has been provided for your convenience. Submission of incomplete materials will delay your request. In order to facilitate your request, complete and submit the materials with ORIGINAL SIGNATURES. Please retain copies of your materials for your records. You will receive written notification upon approval or denial of your request.
All claims must be received by the current fiscal agent within one year from the date of service. Claims not received in a timely manner (within one year from the date of service) will not be considered for reimbursement except for claims submitted to Medicare, claims determined to be payable by reason of appeal or court decision, or as a result of agency error. Regulations regarding payment of services to out-of-state providers (more than 50 miles from the Kansas border) allow payment consideration for out-of-state services provided to KMAP beneficiaries if one of the following situations exists:
- An out-of-state provider may be reimbursed for covered services required on an emergency basis.
- An emergency is defined as those services provided after the sudden onset of a medical condition manifested by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected to result in placing the patient"s health in serious jeopardy, serious impairment to bodily function, or serious dysfunction of any bodily organ or part.
- In these situations, contact the KMAP Prior Authorization department to receive authorization prior to services being rendered. Failure to contact the Prior Authorization department may result in denial of your claim.
- An out-of-state provider may be reimbursed for nonemergency services if the Prior Authorization department, on behalf of the Kansas Department of Health and Environment, Division of Health Care Finance (KDHE-DHCF), determines that the services are medically necessary.
Note: Failure to meet either of the above situations may result in denial of your claim.
If either situation presently exists or may exist, then complete the application and provide all of the requested information.
If you have questions concerning enrollment, contact Provider Enrollment.
- P O Box 3571, Topeka, Kansas 66601
- 785- 274-5914 (between 8:00 a.m. and 4:30 p.m., Monday through Friday)
Please click the "Continue" to proceed.