Search

Skip secondary navigation

View more about

Provider Forms and References | UnitedHealthcare Community Plan of Kansas expand_more
Kansas Provider Grievance Form
Kansas Provider Referral Online Form
Kansas Provider Appeal Online Form

Provider Forms and References

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Medical Necessity Form
Entity / Group Provider Disclosure of Ownership and Control Interest Online Form
External Independent Third Party Review - Associated Costs
Kansas Primary Care Physician Lock-In Referral Form
Kansas Provider Appeal Online Form
Kansas Provider Grievance Online Form
Kansas Provider Referral Online Form
Kansas Sterilization Consent 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.

Expand All add_circle_outline

Prior Authorization / Pre-Certification Forms

Visit the Prior Authorization Page

Provider Portals

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

Submit a Pre-Service Appeal and or Grievance for a Medicaid Member

Medicaid Pre-Service Appeal or Grievance