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Medical Policy and Clinical UM Guidelines

View our medical policies and clinical UM guidelines

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Kansas HealthWave 19 and 21

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Welcome to our State Sponsored Health Plans

 
Kansas Provider Resources and Contracting Materials
We're dedicated to HealthWave (Medicaid and Children’s Health Insurance Program) populations and those who serve them. Learn more about our programs.  
We invite you to join us. Call today to speak with a member of our provider recruiting team at 1-877-604-0462.  
The following "State Sponsored Business Practice Information" documents are available for download:  
 
Recruiting and Contracting Materials
Request for Professional Provider Practice Information (Contract Application)
Provider Recruiting Information
 
Provider Communications
CHIPRA, February 2009
Desktop IVR Reference Guide
Provider Newsletters
Provider Bulletins
Quality Improvement Program Available for Providers Upon Request
 
Programs and Services
Health Education Programs
Pharmacy
Interpreter Services
 
Policies, Manuals, and Guidelines
Advanced Directives
Unicare Medical Policies
Clinical Practice Policies
Preventive Health Care Guidelines
Member Handbook/Evidence of Coverage (PDF)
Provider Directory (PDF)
Provider Operations Manual and Important Updates
20 Principals of Customer Care (PDF)
HEDISĀ® Descriptions (PDF)
HEDIS Measure Physician Documentation Guidelines and Administrative Codes (PDF)
Provider Fee Schedule (PDF)
This is a base schedule of covered benefits and does not imply any specific contractual arrangements or billing formats.
 
Prior Authorization and Pre-Service Review
Prior Authorization Toolkit
Request for Preservice Review
Services Requiring Prior Authorization
 
Forms and Tools
Forms and Tools Library
EFT/ERA Enrollment Form
Notice of Privacy Act (PDF)
Physician Appeal Process for Medical Necessity or Experimental/Investigational Adverse Determinations (PDF)
Clinical Utilization Management Guidelines (PDF)
Urgent Care Clinic List
 
National Provider Identifier (NPI)
URGENT NOTIFICATION This Message Affects Claims Submitted for Medicaid Services Medicaid Claims without Appropriate NPI will Deny Effective December 1, 2008
NPI: Professional 837 Enumeration and Contractual Chart
NPI: Institutional 837 NPI Enumeration and Contractual Chart
National Provider Identifier Fact Book
NPI FollowUp on Key Items
NPI and How to Submit Claims
 
 
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