Network Provider Acknowledgment

Your practice is participating in our Medicare Advantage network (Wellcare) and Health Insurance Marketplace network (Ambetter), effective January 1, 2026.

If you have questions about Wellcare, Ambetter or Medicaid, please contact us at one of the numbers below:

Sunflower KanCare Medicaid: 1-877-644-4623
Ambetter from Sunflower Health Plan: 1-844-518-9505
Wellcare:
- 1-800-977-7522
- D-SNP 1-844-796-6811
TTY: 711

Enrollment Attestation

Practice Name *

TIN *

Additional TINs Please list any additional TINs that should be represented on this form.

Practice Phone

Attester Name

Attester Title

Attester Email

Attester Phone Number

wellcare logo

I acknowledge and understand that the above-named practice is part of the Wellcare network. Acknowledged

I acknowledge and understand that the above-named practice is part of the Ambetter network. Acknowledged