Skip to Main Content

Change Accepting New Member Status

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.

Ambetter logo Wellcare logo

Ambetter or Medicare Change Accepting New Member Status

Please use the form below to change whether your practice is accepting new members.

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

First Name *

Last Name *

Provider NPI *

Tax ID # *

Group/Facility Name *

Group NPI # *

Service Location Address

Street Address *

Address Line 2

City *

State *

ZIP / Postal Code *

Provider Type * Primary Care Provider (PCP) Specialist

Is Provider Accepting New Members? * Yes No

Comments

Update Requested By:

First Name *

Last Name *

Contact Email *

Contact Phone *