Provider Roster Submission Details

Date: 10/22/20

In order to maintain a current provider profiles, prevent billing delays and allow member access to the most accurate listing of practitioners, groups/facilities/hospitals for Ambetter or Allwell are required to submit a roster. For Medicaid providers, the roster submission is optional, but KMAP enrollment is required. The purpose of the roster is to communicate provider additions, terminations and changes.

Access the Roster (Excel)

Changes must be received at least 30 days in advance of seeing members, so that the practitioner may be enrolled and credentialed before providing services. Providers will receive a credentialing letter with a credentialing date. A welcome letter will follow the credentialing letter that has the effective date, which is the participating date or PAR date. This is the date on and after a practitioner may begin seeing members.

Send your Completed Roster via Email

If you have credentialing or contracting questions, please connect with our Network team by sending an e-mail. Additional Join Our Network information is available on our website.

If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.