New Kansas Medicaid Modular System
Date: 09/22/21
Attention: Electronic Billing Trading Partners
Kansas Medicaid is transitioning to a new processing and payment system effective January 18, 2022.
The Kansas Department of Health and Environment (KDHE) awarded the Kansas Medicaid contract to design, develop, test and implement a new Kansas Medicaid Modular System (KMMS). Gainwell Technologies was selected to continue in this role as the KMMS contractor and Fiscal Agent.
The overall goal is to replace the legacy Medicaid Management Information System (MMIS) and Fiscal Agent services with a service delivery model that is both flexible and adaptable with business intelligence and analytic tools that will provide easy access to data and comprehensive reporting.
The HIPAA 5010 rules for the Standard for Electronic Transactions became effective on October 16, 2000. Prior to its implementation, health care providers and plans used many different electronic formats for a variety of electronic transactions. Under HIPAA, the electronic transactions final rule adopted electronic transaction standards, which are now implemented by the KDHE.
The rules require health care providers that send transactions such as inquiries of eligibility or claims for payment electronically to use the current standards adopted by this rule. It requires health care plans to accept electronically submitted transactions using only these standards.
Additionally, trading partners must comply with current guidelines outlined in the National Council for Prescription Drug Programs (NCPDP) Version D.O, which defines the data structure and content of single point of sale (POS) transmissions.
More information will be communicated to trading partners in the coming months. In preparation for the KMMS modernization project, please make sure trading partner contact information with Kansas Medicaid is up to date.
Please refer to the KMAP website for additional bulletins outlining this information.
If you have questions about this bulletin or other provider resources, please our Customer Service Center at 1-877-644-4623.