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Provider Enrollment

Welcome to the Kentucky Medicaid provider enrollment website

Thank you for choosing to participate in the Kentucky Medicaid Program. The Kentucky Medicaid Program appreciates your interest and welcomes the opportunity to work with you to provide health care services to Kentucky Medicaid members.

If you have any further questions or need assistance, please either email us or call toll free: (877) 838-5085 Monday to Friday 8 a.m. - 4:30 p.m. ET.

Note: Please read the Important Provider Enrollment Information regarding new phone hours and email address.

Provider Enrollment Updates

Important Announcement

Aug. 26, 2014 - Provider participation in the Kentucky Medicaid Program is through the Provider Licensing and Certification Branch, Division of Program Integrity, Department for Medicaid Services, Cabinet for Health and Family Services. Requirements for enrollment and continued participation (maintenance) are governed by federal and state laws and regulations including, but not limited, to 42 CFR 455 and 907 KAR 1:671 and 907 KAR 1:672. Review the Provider Enrollment Process.

Once enrolled, a provider is required to file an Annual Disclosure of Ownership; is subject to revalidation every five years; must keep his or her license up to date; and notify Medicaid immediately of any changes in information on file.

Electronic Annual Disclosure of Ownership Update

Jan. 22, 2014 - The Electronic Annual Disclosure of Ownership (EADO) process has been temporarily disabled for system maintenance. If you have an EADO currently in process, you may be contacted for further information if additional information is need to process your EADO.

Important Announcement regarding newly enrolling provider types and other changes for enrollment due to the Medicaid expansion

Nov. 18, 2013 - Below is a list of new provider types that we anticipate enrolling effective Jan. 1, 2014 due to Medicaid expansion under the Affordable Care Act. Please note that the new provider types are subject to change pending CMS approval. In addition, the regulations and enrollment requirements for each provider type are still being developed.

Starting Nov. 18, 2013, providers may submit an enrollment application for these new provider types. Although enrollment requirements are still being determined, each entity/individual must be licensed and submit their NPI documentation as well as SSN or FEIN verification. Applications will be held and processed once CMS approval is received and the regulations and enrollment requirements are finalized. DMS will provide new information as it becomes available.

As with the current enrollment process, if a provider will be contracting with an MCO the provider will need to submit their application through the MCO of their choice.

New Provider Types

  • 18   - Private Duty Nursing Agency
  • 66   - Behavioral Health Multi-Specialty Group
  • 79   - Speech Language Pathologist
  • 799 - Speech Language Pathologist Group
  • 81   - Licensed Professional Clinical Counselor
  • 819 - Licensed Professional Clinical Counselor Group
  • 83   - Licensed Marriage and Family Therapist
  • 839 - Licensed Marriage and Family Therapist Group
  • 84   - Licensed Psychological Practitioner
  • 849 - Licensed Psychological Practitioner Group

The QMB limitation will be removed from these QMB Provider Types Revised effective Jan. 1, 2014 subject to CMS approval. If you are currently enrolled in this provider type you will automatically be transitioned:

  • 82   - Licensed Clinical Social Worker
  • 87   - Physical Therapist
  • 879 - Physical Therapist Group
  • 88   - Occupational Therapist
  • 889 - Occupational Therapist Group
  • 89   - Licensed Psychologist
  • 899 - Licensed Psychologist Group

Attention Providers

April 11, 2013 If you are enrolling in KY Medicaid and will be participating with any of the Managed Care Organizations (MCOs), you will need to send your enrollment application to one of the MCOs of your choice.

Do not submit enrollment applications directly to KY Medicaid unless you are NOT participating with any of the MCOs.

  • Coventry - 855-300-5528
  • Humana Caresource - 800-457- 5683
  • KY Spirit - 866-643-3153
  • Passport - 800-578-0775
  • Wellcare - 877-389-9457

Region 31 Provider Enrollment Notice

Jan. 1, 2013 - Providers if you would like to request participation as a Humana - CareSource Provider, Please call 1-800-457-5683 or email us at ProviderMedicaidEnrollment@Humana.com.

Provider Enrollment Notice

Sept. 12, 2013 - If you are a home medical equipment provider and are required to be licensed by the KY Board of Pharmacy as such, please submit a copy of your license to KY Medicaid. For more information regarding this new requirement (effective Sept. 30, 2012), please visit the KY Board of Pharmacy's website. Please mail a copy of your license to the following address:

KY Medicaid
PO Box 2110
Frankfort, KY 40602

Please also include your KY Medicaid provider number on the copy of the license.

September 2011

(Sept. 28, 2011) - When sending any type of correspondence to Kentucky Medicaid provider enrollment, please write your NPI and/or Kentucky Medicaid provider number on each document. If you submit documents for multiple providers submitted in the same envelope, please staple or paperclip each providers own documents separately. Although, we prefer that you do not attach multiple providers' documents in the same envelope.

June 2011

March 2011

2010 Enrollment Updates

Excluded Providers

On Jan. 16, the Centers for Medicare and Medicaid Services issued a letter to state Medicaid directors reiterating a long-standing policy. The letter clarifies the federal statutory and regulatory prohibitions regarding providers who have been excluded from participation in Federal Health Care programs. For more information please review the following letters.

You may also visit the Office of the Inspector General Exclusions Program website for the List of Excluded Individuals/Entities.

Updated Kentucky Medicaid Excluded/Termed Provider Listing

 

Regulations, Publications, Termed Provider List
   

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. ET
Email: Program.Integrity@ky.gov

For other questions or assistance, e-mail the CHFS DMS Webmaster

For question on billing, contact HP at (800) 807-1232 or visit their website.

 

Last Updated 9/30/2014
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