Change Panel Size (PCP Only)

KanCare Provider Enrollment and Changes: Providers must use the Kansas Modular Medicaid System (KMMS) Provider Enrollment Wizard to update their information for any or all of the Medicaid fee-for-service (FFS) and managed-care organization (MCOs) health plans.

Medicare or Ambetter Change Panel Size (PCP Only)

Please use the form below to change your practice's panel size for Ambetter or Medicare members.

Change Status for: * Ambetter (Health Insurance Marketplace) Medicare (Allwell / Wellcare)

Provider NPI *

Primary Care Provider (PCP) Name

First Name *

Last Name *

Tax ID # *

Group/Facility Name *

Group NPI # *

Service Location Address

Street Address *

Address Line 2

City *

State *

ZIP / Postal Code *

New Ambetter Panel Size

New Allwell/Wellcare Panel Size

Comments

Update Requested By:

First Name *

Last Name *

Contact Email *

Contact Phone *