MedicaidDocumentationMedium impact
KMAP BULLETIN: UPDATED EPSDT Medical Necessity Form
Kansas Medicaid (KanCare)·KS · Pediatrics, Family Medicine, General Practice·Provider Bulletin
Effective date
Nov 1, 2023
We identified it
Jun 21, 2026
Summary
Kansas Medical Assistance Program updated the EPSDT Medical Necessity Form for providers requesting medically necessary non-covered services for pediatric patients. Providers can now use this standardized form when MCOs request additional information during the prior authorization process for EPSDT services.
Action Required
Immediately: Download the updated EPSDT Medical Necessity Form from KMAP portal. Train billing and clinical staff on when to use this form - specifically when MCOs request additional information for non-covered EPSDT services during prior authorization. Update prior authorization workflow to include this form as supporting documentation for pediatric Medicaid cases when requested by MCOs.