KMAP BULLETIN: ADAPD Claims Processing Point of Contact
Date: 02/27/24
KMAP PHARMACY BULLETIN 24049 (PDF)
The Kansas AIDS Drug Assistance Program (ADAP) is a statewide program that provides eligible members medications for the treatment of HIV/AIDS. The Kansas ADAP works collaboratively with the Division of Health Care Finance (DHCF), also referred to as the state's Medicaid Program. Through this partnership, the Kansas Care Program maintains the eligibility of the ADAP while the Medicaid Program oversees the claims processing of the program.
Services are available to all eligible members within the Kansas ADAP. These services provide reimbursement for medications listed on the Kansas ADAP Medication Formulary. To verify ADAP formulary coverage please use the National Drug Code (NDC) Code Search on the KMAP website here.
ADAP funding is considered the payer of last resort, which means if a member has access to other forms of support, such as private insurance or regular Medicaid, those forms of support must be utilized first.
Retail pharmacy claims for AIDS Drug Assistance Program Drug (ADAPD) members must be submitted through the member’s Kansas Medicaid claims processor. The Kansas Medicaid claims processor varies based on a member’s enrollment for the date of service. If you have issues or questions processing claims for an ADAPD member, please contact the member’s claim processor.
Retail Pharmacy Claim Processor Point of Contact (POC):
- Fee-for-Service (FFS)
- Kansas Medical Assistance Program (KMAP): 800-933-6593
- Managed Care Organization (MCO) – Direct to MCO’s Pharmacy Benefit Manager (PBM)
- Aetna: 844-234-8268
- Sunflower: 877-644-4623
- United Healthcare: 877-305-8952
If you are unsure of the member’s claims processor, please use the Member Eligibility Verification system on the KMAP Provider Secure Portal or contact KMAP Customer Service.