You must have an active Kansas Medicaid ID to complete the credentialing process. Don’t have one? Visit the KMAP website and complete the provider enrollment application.
We only accept credentialing of new professional applicants through the Council for Affordable Quality Healthcare
If you have a valid Kansas Medicaid ID: Visit CAQH and use your current CAQH ID to grant Amerigroup access to your credentialing file; then complete our online application request, the attached Kansas Disclosure of Ownership and Controlling Interest Form, and a current W9.
If you do not currently participate in CAQH: Complete our online application request. We will then nominate you in the CAQH database, allowing you access to the database in order to complete the application.
We cannot initiate credentialing unless all information is current in CAQH. Your application for credentialing does not guarantee network participation. You cannot begin to see Amerigroup members until you receive notification of your effective date for participation with Amerigroup Kansas, indicated by both an executed contract and completed credentialing.
If you are new to the Amerigroup network, you will require both credentialing and a contract. Please complete each of the forms below and return them to:
fax: 1-866-494-5632email: firstname.lastname@example.org
Joining an Existing Amerigroup Contracted Provider Group?
We only require your CAQH number to credential and add a professional provider to an already contracted entity.
We accept the State of Kansas Facility Joint MCO Application for all Facility, Ancillary and HCBS providers.
Please complete the Updated Roster November 2017.
Call the Amerigroup Kansas Provider Relations team at 877.434.7579 if you have questions.