You'll find all forms we currently use in the following list.
We're currently reviewing all forms in an effort to make it easier and simpler to work with us, so check back frequently to see what's changed.
National Disclosure Provider Roster Addendum Form (PDF 42.73 KB)
Providers can use the Prior Authorization Form (PDF 228.04 KB) to fax in a prior authorization request.
PCP Change Request Form (PDF 231.42 KB)
Providers can click here (PDF 27.47 KB) for information regarding the process to follow to submit unsolicited refunds to UnitedHealthcare Community & State for the KanCare program. Click here (XLS 24 KB) for the spreadsheet providers can use to document information regarding the refund.
Refer to the KDHE Pharmacy website for prior authorization criteria and forms.
Providers can click here (PDF 401.58 KB) to access the Provider Demographic Change Form to submit or to make changes to their demographics like address, phone number, change in practice name, adding a physician, etc. The form includes instructions on how to submit the form when it's completed.