Provider/Practitioner Changes

Please note that all participating Medicaid providers must be enrolled with KanCare and have a KMAP ID for each servicing location by January 1, 2019. Medicaid providers, participating or non-participating, will not be paid for services if billed without a valid KMAP ID.

The Kansas Modular Medicaid System (KMMS) Provider Enrollment Wizard is available for use for Kansas Medical Assistance Program (KMAP) providers. Providers can enroll in any or all the health plans – fee-for-service (FFS) and managed care organizations (MCOs) – through a single application. Please go to the Provider Enrollment System to begin this process.

For all changes and/or updates, please reference the provider change form instruction sheet before submitting any of the below forms.

• Fillable Provider Change Form and Instructions (PDF) - Any changes in address, telephone and fax numbers, NPI numbers, and provider status (moved out of area, retiring, capacity changes, etc.) must be communicated to Sunflower through this form.
• Preferred Sunflower Roster Format (Excel) - Any practitioner additions, terminations or changes for multiple practitioners must be submitted to Sunflower Provider Relations via email. Note: For delegated credentialing, the CAQH number is not necessary on the Sunflower Roster. Please use the Preferred Delegated Sunflower Roster Format (Excel)

  How to complete the Sunflower Roster Form:

  1. Click the above “Sunflower Roster Format” hyperlink
  2. Select “Save” to save to your computer
  3. Locate and open the saved Roster from download
  4. Review “Important Notes” tab
  5. Complete all applicable fields in yellow “Roster Form” tab
  6. Save and email to Sunflower Provider Relations
• Fillable CAQH Provider Data Form and Instructions (PDF) - Alternative to the Sunflower Roster Form. For practitioners who are already registered on CAQH, additions may be submitted on a CAQH provider data form. Only provide information for one practitioner per CAQH Provider Data Form.
• Fillable KMAP Disclosure of Ownership and Controls Form (PDF) - Group providers not a part of a health system are required to submit a Disclosure of Ownership form for each practitioner being added to the group.
• KanCare Credentialing Documents
  • Standard Credentialing Application
  • HCBS Supplemental Form
  • KanCare Credentialing FAQs (PDF)
• Fillable W-9 Form (PDF)

Practitioner Rights

Practitioners have the right to obtain the status of their application at any time throughout the credentialing process and the right to review information submitted to support the credentialing application. Practitioners also have the right to correct erroneous information, should any information obtained from other sources vary substantially from the information provided with the application. Should that occur, you will be notified by the Sunflower Health Credentialing Department and will have thirty (30) days to correct the information. To obtain credentialing status, or if you have questions about these rights, please contact the Sunflower Contracting Department at 1-877-644-4623.