Members
You won’t lose your health coverage. KDHE will let you know when it’s time to choose a new plan. It will start on January 1, 2025. Learn more about these plan changes (PDF).
Questions about your plan? Visit the KanCare website to learn more about Medicaid plans.
Providers
Our contract with KDHE expired at 11:59 PM CT on 12/31/2024. We’re no longer receiving and processing authorizations and new admission notifications. You still have access to the full provider site through December 31, 2025.
Questions about claims or other provider topics? You can read more in the provider notice (PDF) and transition bulletin (PDF).
If needed, you can still visit the Availity Provider Portal.
More helpful information and resources
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What is a claim resubmission?
The purpose of a resubmission is to get a clean claim on file. You have 365 days from the date of service to resubmit a revised version of a processed claim.
What is a claim reconsideration?
A claim reconsideration is a request that we previously received and processed as a clean claim. The purpose of a claim reconsideration request is to dispute/request review of the processing of a clean claim. A clean claim must be on file prior to submitting a reconsideration request. Providers have 120 days from the date of the Explanation of Benefits (EOB) to file a reconsideration.
What is a claim appeal?
Both in-network and out-of-network providers have the right to appeal the result of a decision. You’ll want to file your appeal in writing within 60 calendar days of the reconsideration response (date of EOB).
You can check out the flyer to learn more about our claim resubmission, appeals and reconsideration processes.
Claim resubmission, appeals and reconsideration information flyer (PDF)
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Appeals
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Filing an appeal
Both in-network and out-of-network providers have the right to file an appeal in writing if:
A service, supply or procedure is medically necessary (include documentation)
A payment decision wasn’t in their favor
They aren’t satisfied with the outcome of the reconsideration determination
They wish to bypass the reconsideration process
Providers have 60 calendar days from the date of the notice of adverse action or reconsideration decision letter to file an appeal. Post service items or services are standard appeal and are not eligible for expedited processing.
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Be sure to submit your appeal within the specific timeframes and follow all requirements.
You can submit all appeals to this email address: KSAppealandGrievance@Aetna.com
What happens next?
Within 10 calendar days: We’ll send you a letter saying that we received your appeal, including instructions on how to:
- Revise the appeal within the time frame specified in the letter
- Withdraw an appeal at any time until the Appeal Committee review
Within 30 calendar days: We’ll tell you our decision.
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We send your appeal and our research to the Appeal Committee for a decision. The committee includes a provider in the same or similar specialty. They review any extra information you send and mail you a written decision.
Health professionals complete clinical appeal reviews. They include those who:
Hold an active, unrestricted license to practice medicine or in a health profession
Are board certified (if applicable)
Are in the same profession or in a similar specialty as normally manages the condition, procedure or treatment concerned in the case
Are neither the same reviewer that made the original decision nor someone who reports to that person