Provider Forms and Reference Guides
- Entity / Group Provider Disclosure of Ownership and Control Interest Online Form
- Kansas Provider Appeal Online Form
- Kansas Provider Grievance Online Form
- Kansas Provider Referral Online Form
- KanCare Medicaid Behavioral Health Inpatient Prior Authorization Request Form
- KanCare Medicaid Behavioral Health PRTF Prior Authorization Request Form
- Obstetrics / Pregnancy Risk Assessment Form
- OptumRx Commercial and Medicaid Payer Sheet - This document provides information on electronic claims processing, specific to NCPDP defined fields and requirements, for OptumRx Commercial and Medicaid business.
- OptumRx UnitedHealthcare Community Plan of Kansas (Dual Eligible Only) Payer Sheet - This document outlines the processing instructions for OptumRx UHC Plan of Kansas (Dual Eligible Only) business.
- U.S. Department of Health & Human Services Consent for Sterilization Form
- UnitedHealthcare Disclosure of Ownership, Management and Control Interest Form - Addendum to Previous Group Disclosure Form/Roster Submission
The following links will bring you to each provider portal.
- KanCare - Medicaid for Kansas
- Kansas Department of Aging and Disability Services (KDADS)
- Kansas Department of Health and Environment (KDHE) / Division of Health Care Finance (DHCF)
- Kansas Medical Assistance Program (KMAP)
- MARCH Vision Care
- Logisticare - Kansas transportation providers
- SkyGen - SkyGen Dental, Vestica Healthcare and Ocular Benefits