Kansas Medicaid Assistance Program (KMAP) revalidates providers enrolled in Medicare on an average of every three (3) years. During COVID, revalidations ceased. In May 2023, the state of Kansas reinstated the revalidation process, which included the revalidation notices being sent to the Credentialing Contact who was on file at the time. There were times that KMAP had outdated information on the current Credentialing Contact. Therefore, the notices were not going to the correct individual. As a result, the revalidation was not completed, and the provider was deemed out of network.
This proved to pose a much larger issue because if the provider is out of network with KMAP, it also affects the MCO enrollments of Aetna Better Health, Sunflower, and United Healthcare. When this happens, providers receive termination letters that the revalidations were not completed, and the provider is now considered out of network. Patients receive similar letters advising that the provider is out of network, and are given instructions to find another provider.
In one example, a provider who was due for revalidation in December of 2024 was actually terminated in June or July of that same year. It was found that KMAP was using the 12/2024 date as a “place holder” to prevent the provider from being terminated. However, due to not have accurate contact information, the new revalidation notice was not received and the provider was terminated anyway.
In August of 2023, the Provider Enrollment (PE) Team at Medical Provider Resources (MPR) held a conference call with key individuals of the administrative team of the PE Team at KMAP to address the issue. The team from KMAP acknowledged there was a problem with the process, however, they had not yet created a resolution for it. To address the situation, the PE Specialists within MPR performed audits on their KMAP providers to determine when the provider was due for revalidations. There were times when a date was not available so KMAP would list “TBD” (To Be Determined). In this case the MPR PE Specialist would have to continue to follow up with KMAP on the revalidation date.
Another challenging factor with KMAP’s system is that the Credentialing Contact and contact information is not consistently and accurately reflected on record. It was advised that the system has limitations. If a provider goes to multiple organizations and has multiple contacts, the system does not know which group is primary. If the provider leaves the primary group, KMAP would arbitrarily choose another group as the primary contact without confirming this with the provider. There were times when the notice went to a previous Credentialing Contact, who would then have to forward the notice to the correct Credentialing Contact. The revalidation was completed with the new Credentialing Contact’s information but the approval letter was still sent to the previous contact’s email. To date, MPR has not received all of the revalidation dates on record and has not been able to successfully change the contact on record, if necessary.
MPR has identified several practice groups and hospitals across Kansas who have experienced these challenges as well. We have begun working with Kansas Hospital Association (KHA) as well as local practice managers and med staff professionals to partner on a resolution with KMAP. In doing so, we have been advised that KHA has already started the conversation with KMAP to work to address the matter. Our involvement could help strengthen the voice and provide a clearer picture of the fallout this has caused to our providers and patients. Thus, MPR has planned to host a virtual KMAP Revalidation Discussion on December 10, 2024 from 3:00 – 4:30 PM. Please RSVP to Marla Booher, CEO, (marlabooher@mprcred.com) to receive an invite to join us for that discussion. We look forward to serving as an advocate toward a full resolution of this matter.
