WORK – Healthy Blue

Procedures & Information

Acceptance of Responsibility for Employment Adverse Action Notice Adverse Action Notification Letter Agency & Vendor Welcome Letter Coversheet Employer Checklist FCRA Summary of Rights How to Read your Budget summary KS Healthy Blue PROVIDER INVOICE INSTRUCTIONS Pre-Adverse Action Notice Pre-Adverse Action Notification Letter Provider FAQ Provider Information Form Provider checklist W9 Instructions Workers’ Compensation Claim Information

Payroll Documents

Agency Independent Contractor Direct Deposit Information Agency Vendor Invoice Direct Deposit Application Direct Deposit Information Direct Deposit Information Guide Independent Contractor Invoice KS AGENCY VENDOR INVOICE KS INDEPENDENT CONTRACTOR INVOICE KS WORK Healthy Blue Invoice Schedule 2025 KS WORK Healthy Blue Pay Schedule 2025 KS Work Participant direct Deposit Form (Fillable) Payment Change Form Payment Change Form Provider Rate Change Form Rate Changes Reimbursement Form Vendor Payment Change Form

Referral & Enrollment Process

Agency Directing Employer Enrollment Packet Agency Vendor IC Enrollment Packet Application for Tax Exemptions Application for Tax Exemptions Criminal Background Check Application Criminal Background Consent Employee Change of Information Federal Form W-9 K-CNS 010 KS Adult Abuse, Neglect, Exploitation Central Registry Release of Information KS Child Abuse and Neglect Central Registry Release of Information KS Form K-4 Provider Application Request Form Provider Change of Information Form Provider Information Form Provider Packet Blank Separation of Employment Form Separation of Employment Form Tax Exempt Instructions Verification of Employment Pre-Population

BetterOnline™

Carryover Authorizations FAQ Carryover Authorizations Instructions

Time4Care™

Time4Care Mobile App Instructions