PAYER ENROLLMENT INSTRUCTIONS FOR MC012
Medicaid,
Kansas - ERA
ERA Before enrolling please be sure your Capario contract includes the transactions you will be using. Transactions are available as an additional Capario contracted service. Please ensure you are contracted
with Capario
to request Electronic Remittance BEFORE requesting ERAs through Capario for this payer. If you
Complete the payer enrollment process BEFORE submitting claims to Capario for this payer. If you are unsure
about
your current status please contact Capario sales at: [email protected] or 800-586-6870.
are unsure about your contract status please contact Capario Support team at: [email protected] or 800‐792‐5256. EFT enrollment
and transmission is an arrangement between the provider and the Payer. If the Payer offers EFT
transactions contact them to determine if they:
We recommend enrolling using our Portal enrollment tool. This free Portal tool allows you to enter • Require
you to receive EFTs in order to receive their ERAs
• Charge
an additional fee for EFTs/ERAs
Providers and select the payers and transactions for your enrollment as it prefills the agreement • Require you to enroll for EFTs on this ERA enrollment form.
forms for you. Another advantage of the enrollment tool is the ability to follow the progress of enrollments from initial generation through to payer approval. Our team will set you up and provide We recommend
enrolling using the convenience of our enrollment tool located on the Capario portal. This tool
allows
you
to
enter
providers, select the payers and transactions for which you want to enroll, and produces
a quick tutorial. Contact us at [email protected] pre-filled forms for processing. If you are not currently using the Capario portal, you can contact us at
[email protected]
and our team will ensure that you are set up and will provide a quick tutorial on using the
enrollment tool.
If you are not enrolling with the free portal Enrollment tool, please following these instructions: Enrollment can be completed without the enrollment tool by following the specific instructions for this payer shown
If this payer does not require an agreement, go to Step 2. below.
STEP 1: COMPLETE AGREEMENT 

Complete all required fields on agreement and verify that information entered is correct. If an agreement requires signatures, we recommend signing in blue ink. Do not use signature stamps. STEP 2: PROCESS Fax or mail the completed Kansas MMIS EDI Application to:
HP Enterprise Services / EDI Department
P.O. Box 3571
Topeka,,
KS 66601-3571
Fax: (785) 267-7689
**NOTE**
After processing the Kansas MMIS EDI Application, Kansas Medicaid will send an
email regarding the posting of ERAs to the KMAP website. You MUST log into this website
and follow
the instructions for selecting a different account for posting ERA transactions in
order to add Capario as your ERA Receiver. On the Account Maintenance page you will
enter username: Proxymed
STEP 3: COMPLETE CAPARIO ENROLLMENT SPREADSHEETS 

Capario Provider Spreadsheet – This is completed for each new provider. http://www.capario.com/downloads/xls/provider_bulk_spreadsheet.xlsx Capario Payer Enrollment Spreadsheet – This is completed when requesting enrollment with a payer for providers previously added to the Capario system. Please refer to the instruction tab on each spreadsheet form for details about the information to enter in each column. **PLEASE NOTE** The fields for tracking information are key for both your record keeping of enrollments and for Capario following up with payers for approvals. Be sure to enter all tracking for each enrollment. http://www.capario.com/downloads/xls/enrollment_bulk_spreadsheet.xlsx Email the completed spreadsheet(s) to: [email protected] Questions? Contact us: Phone: (800) 792‐5256 Option 1 Fax: (404) 877‐ 3324 Email: [email protected]
Kansas MMIS Electronic Data Interchange Application
INSTRUCTIONS FOR EDI APPLICATION
An electronic data interchange (EDI) application is necessary for billing entities submitting electronic
transaction files. It is not applicable if submitting PAPER claims or submitting claims on the Kansas Medical
Assistance Program (KMAP) website.
Section 1
Fill in the entity type and contact information.
Section 2
Indicate the software the billing entity will use. If the software is not Provider Electronic Solutions, indicate the
name of the software that will be used.
Section 3
Select only one submission method. This is the method by which the billing entity intends to deliver the
electronic information to KMAP.
Section 4
Select all of the transaction types the billing entity will submit to or retrieve from KMAP.
Section 5
This section contains information on how to return the completed EDI application to KMAP.
All applications must include name, signature, title, and date of completion.
For assistance with this form, call the EDI Help Desk at 1-800-933-6593, option 4,
or email them at [email protected].
Kansas MMIS Electronic Data Interchange Application
1. Complete this section:
ˆ Clearinghouse
Billing Entity Type:
x Provider __________________________________
ˆ
KMAP Provider ID Number
Business Name: ______________________________________
Address: ______________________________ City: __________________ State: ____ Zip: ______________
Contact Person: ________________________________ Contact Telephone: _____________________________
Email Address: ___________________________________________________
2. Please choose any that apply:
What software will the billing entity use?
x Provider Electronic Solutions
ˆ
ˆ Other
__________________________________
Software Name
3. Please select only one submission method:
ˆ RAS file transfer
(Trade Files-Batch)
x Internet file transfer
ˆ
(Trade Files-Batch)
4. Select ALL electronic transaction types you wish to test using media type selected in Section 3:
5010 Transaction files
ˆ 837 Professional
x 835Remittance/277 Pended Claims
ˆ
ˆ 834 Benefit Enrollment
ˆ 837 Institutional
ˆ 270/271 Eligibility
ˆ 820 Capitation Payments
ˆ 837 Dental
ˆ 276/277 Claim Status
ˆ 278 Prior Authorization
5. Complete this form and return it:
By fax:
785-267-7689
By mail:
HP Enterprise Services
EDI Department
P O Box 3571
Topeka, KS 66601-3571
_________________________________
_____________________________
Signature
Title
____________________
Date
_________________________________
Printed Name
Last Revised 1/4/2012
Important: Disregard this application if the billing entity is ONLY
submitting paper claims or using direct data entry on the KMAP website.