Internet Telephony Service Providers (ITSPs)

Forms
ENROLLMENT and DISENROLLMENT FORM - KMAP
Below is a checklist to ensure all the necessary forms are...
Provider Workshop: - KMAP
Hospital09252009985.doc
UB-04 Instructions
General Billing 973 from 897.doc
Pharmacy Providers - KMAP
Kansas MMIS Electronic Data Interchange Application - KMAP
excise kmap form
WORK 08012008 898.doc
Consent for Sterilization Form Update - KMAP
Hospital 07252008 8112.doc
Mental Health Providers New Provider Specialties - KMAP
Hospital 03312008 846.doc
Hospital0108201010003.doc
ks disclosure 2014 form
EDI application - KMAP
healthconnect kansas contract change form.doc. Zimmer Revitan Gerade Operationstechnik
UPDATED Nursing/Intermediate Care Facility Providers - KMAP
STANDARDIZED APPLICATION CHECKLIST - KMAP
HCBS application - KMAP
WORK Work Opportunities Reward Kansans Kansas ... - KMAP
Professional934 from924.doc
PHARMACY 07012008 892.doc
Medical Transportation (NEMT)
BENEFITS AND LIMITATIONS
Drug Manufacturer Secure Web User Application - KMAP
Nursing 0801208 898.doc
CNMENT 03252008 845.doc
Provider Update May 2014 - KMAP
Durable Medical Equipment Providers - KMAP
PART II - KMAP
New Fields for FEB Claims Revised 1500 Claim Form: CLIA ... - KMAP
HealthConnect Kansas Referral Form - KMAP
Facility - KMAP
Certification Primary-Care-Physicians 05.13.doc. This form allows an individual to provide consent for sterilization. Statements are also included for an interpreter, a person obtaining consent, and a physician. The form
ADA Dental Claim Form Instructions - KMAP
CNEMT Providers Change to NEMT Transportation Form - KMAP
Dental Providers - KMAP
HOME OXYGEN INFORMATIONAL FORM The following ... - KMAP
Commercial Nonemergency Transportation - KMAP
General Billing - KMAP
Revised 1500 Health Insurance Claim Form Extension - KMAP
Attestation of Compliance with Section 6032 of the Federal ... - KMAP
Supplier - KMAP
PHARMACY914.doc
Pharmacy Claim Form Instructions - KMAP
Professional 08012008 898.doc
1500 Claim Form - KMAP
Nursing 10113 10003.doc
Abortion Necessity Form - KMAP
HCFA-1500 Billing Instructions
KAN Be Healthy (EPSDT) Screening Form - KMAP
Professional101520088149.doc
Form Reordering
8171 - Dental - HCPCS.doc
Topeka, KS 66601-3571
Explanation of Necessity for Hearing Aids form - KMAP
Revised 1500 Health Insurance Claim Form Reminder - KMAP
Individual Adjustment Request form - KMAP
KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER ... - KMAP
PHARMACY951 from 933.doc
Kansas Transportation Spenddown Form - KMAP