KanCare 3.0 Open Claims Resolution Log

The KanCare 3.0 Open Claims Resolution Log, revised October 29, 2026, is a state Medicaid managed care operational document maintained by the Kansas Medicaid program (KanCare) tracking open billing and claims processing errors across its three managed care organizations (MCOs): Healthy Blue, Sunflower, and UnitedHealthcare (UHC). Each log entry identifies a specific claims processing defect, the affected provider or service category, the MCO responsible, and the reprocessing or recovery timeline. The log covers professional, institutional, and hospital claim types across multiple service areas including community mental health centers (CMHCs), hospice, nursing facilities, ophthalmology, pharmacy (Part B drugs and carve-out drugs), and home and community-based services. Several entries document COB logic failures within Healthy Blue's claims system. Issue 887 records that COB logic was not properly implemented when Medicaid is secondary, with a system correction applied December 16, 2025, and cleanup of incorrectly processed claims ongoing. Issue 901 further documents that professional and institutional COB logic caused claims to process as primary when they should have processed as secondary, with reprocessing ongoing and no completion date established. Multiple entries address overpayment recovery obligations. Issue 789 identifies CMHC claims applicable to spenddown that Sunflower paid in error, with recovery letters to be issued to impacted providers and a reprocessing ETA of September 30, 2026. Issue 911 records that Healthy Blue paid procedure code 87661 to hospitals in error, with overpayments to be deducted from future claims and a reprocessing ETA of October 30, 2026. Issue 914 identifies three distinct hospice claims processing errors by Sunflower: claims billed over 60 days paid without a U2 modifier, claims paid without a member hospice election on file, and claims incorrectly manually overpaid at billed charges, with a recovery ETA of October 9, 2026. Rate and HCPCS update entries reflect retroactive payment adjustments across all three MCOs. Issues 916 and 927 address nursing facility and nursing facility for mental health rate adjustments effective retroactively to various dates. Issues 898, 917, 919, and 926 track annual and quarterly HCPCS code additions, revisions, and deletions for 2026, including Part B drug pricing updates for Q3 2026, each applied retroactively to the applicable service date. Issue 928 and 929 address updated DRG weights and rates for inpatient claims retroactive to January 1, 2025 and January 1, 2026 respectively, with Healthy Blue reprocessing pending for both.