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Update a Billing Address

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.

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Ambetter or Medicare Provider Billing Address Update

Please use the form below to submit your updated billing address.

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

Group/Facility Name *

Tax ID # *

Group NPI # *

Billing Address

Street Address *

Address Line 2

City *

ZIP / Postal Code *

State *

Billing Address Phone Number *

Should the 1099 address be updated? Yes (Please attach W9) No

Please attach a completed W9 *

Comments

Update Requested By:

First Name *

Last Name *

Contact Email *

Contact Phone *