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Welcome to the Kentucky Department of Medicaid Services Provider Enrollment Forms webpage.

If you are a new provider, refer to the Enrollment Forms listed below.

If you are an existing provider and need to make changes, refer to the Maintenance Forms listed below.

Enrollment Forms
Maintenance Forms


Contact Information

Kentucky Department for Medicaid Services
Provider Enrollment
P.O. Box 2110
Frankfort, KY 40602
Toll free: (877) 838-5085
Monday to Friday
8 a.m. - 4:30 p.m. EST


For questions regarding this website, e-mail the CHFS DMS Webmaster


Last Updated 1/6/2015
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