This online application form allows users to electronically enter information that is required of all medical practitioners for annual compliance within the state of Kansas.
To access the online compliance application, click on this hyperlink: Compliance E-Form
For instructions on completing the application, reference the following document: E-Form Basic Instructions
Follow each step, paying particular attention to the required fields. It is extremely important that the correct license number is entered in the first field.
The electronic compliance form has an attachment option for convenience in order to attach supporting documents such as a certificate of insurance. Attachments must be in a PDF format.
If the health care provider does not reside in the United States or Puerto Rico, enter the most accurate address possible in the “Street address” field and then enter the city, the state or province, and the country in the “City” field. In the “State” field select “Non-USA” (the last option) and if there is no zip code, enter the number 0 in the Zip field.
For instructions regarding calculation of the correct HCSF premium surcharge, refer to the instructions for the Notice of Basic Coverage or the Non-resident Certification available at: HCSF Forms and Supporting Documents | Kansas Health Care Stabilization Fund
FOR ONLINE PAYMENT:
To access the online payment portal, click on the following hyperlink: KanPay
The KanPay option allows only 10 entries per transaction. If you need to pay for more than 10 providers, you must create/complete additional transactions on the KanPay site.
FOR MAILED PAYMENT:
To download the mail-in payment form, select: HCSF Multi Surcharge Form