Institutional Provider Tools and Resources

Manuals

• Institutional Provider Manual (offsite link)
  • See the Institutional Provider Manual for information on Revenue Codes and Items Not Separately Billable
• Electronic Inpatient Precertification System Manual
• Establishing Secure Access for Providers to Member Information
• Quality-Based Reimbursement Program (QBRP) Portal Manual
• Claims Pricing Manual

Resources

• 2024 State of Kansas Comprehensive Site of Care Specialty Drug Program Prescription Drug List (Excel workbook)
• 2023 New Directions Medical Necessity Criteria (offsite link)
• Apixio Provider Portal and Ensuring Payment Integrity
• Preventive Services Quick Reference Guide
• Remittance Advice - HIPAA Codes (offsite link)
• Diagnosis Codes Exempt from POA Reporting (offsite link)
• 2023 State of Kansas Pharmacy Benefit List
• Exchange, BlueCard and Kansas Provider Networks
• Policies and Procedures (offsite link)
• Outpatient Medical Drug Exclusion List
• No Surprises Act Fact Sheet
• HL7 v2 Specification (Excel document - Updated July 2022)
• Updating Provider Profile Information
• Provider Message Portal - How to Sign up

Credentialing Criteria

• Credentialing Criteria - Facilities
• Practitioner and Facility Credentialing and Re-credentialing
• Credentialing Program Plan Description