Provider Information

Provider Information

​​​​​​​​​​​ Medicaid COVID-19
Information

Kentucky Medicaid enrolls providers based on their provider type. If you are interested in enrolling as a new Kentucky Medicaid provider or are a current Kentucky Medicaid provider who needs to perform maintenance or revalidate, please select the button below.

Enrollment Revalidation Maintenance

Current Kentucky Medicaid Providers

We have created a webpage for each provider type. Each page summarizes the requirements for your provider type. Please refer to the list below to select the provider type for which you need information.

Acquired Brain Injury - PT (17)
Adult Day Care Services - PT (43)
Advanced Registered Nurse Practitioner (ARNP) - PT (78) (789)
Ambulatory Surgical Centers - PT (36)
Audiologist - PT (70) (709)
Behavioral Health Multi-Specialty Group - PT (66)
Behavioral Health Services Organization - PT (03)
Birthing Centers – PT (73)
Certified Community Behavioral Health Clinic - PT (16)
Certified Registered Nurse Anesthetist - PT (74) (749)
Chiropractor - PT (85) (859)
Community Mental Health Services - PT (30)
Comprehensive Outpatient Rehabilitation Facilities - PT (91)
Dentist - PT (60) (61)
Durable Medical Equipment Services - PT (90)
Early Periodic Screening Diagnosis And Treatment Services – Screenings - PT (45)
Early Periodic Screening Diagnosis And Treatment Services – Special Services - PT (45)
Emergency Transportation - PT (55)
Family Planning Services - PT (32)
FQHC/Non-FQHC - PT (31)
First Steps - PT (24)
Health Access Nurturing Development Services (HANDS) - PT (15)
Hearing Aid Dealer - PT (50) (509)
Home Delivered Meals - PT (48)
Home and Community Based Waiver Services - PT (42)
Home Health Services - PT (34)
Hospice Services - PT (44)
Hospitals - PT (01)
Independent Laboratory and Radiological Services- PT (37)
Intermediate Care Clinic for Individuals with Intellectual Disabilities - PT (10)
Intermediate Care Facilities for Individuals with Intellectual Disabilities - PT (11)
Licensed Behavioral Analyst - PT (63) (639)
Licensed Clinical Alcohol and Drug Counselor - PT (67) (679)
Licensed Clinical Social Worker - PT (82) (829)
Licensed Marriage and Family Therapist - PT (83) (839)
Licensed Professional Art Therapist - PT (62) (629)
Licensed Professional Clinical Counselor - PT (81) (819)
Licensed Psychological Practitioner - PT (84) (849)
Licensed Psychologist – PT (89) (899)
Model Waiver II Services - PT (41)
Multi Therapy Agency - PT (76)
Non-Emergency Transportation - PT (56)
Nursing Facility - PT (12)
Occupational Therapist – PT (88) (889)
Office of Children With Special Health Care Needs – PT (22)
Optician - PT (52) (529)
Optometrist - PT (77)(779)
Pharmacy - PT (54)
Physical Therapist – PT (87) (879)
Physician Assistant – PT (95) (859)
Physician Services - PT (64) (65)
Podiatry Services – PT (80) (809)
Preventative Care and Remedial Public Health Services - PT (20)
Primary Care - PT (31)
Private Duty Nursing (PDN) - PT (18)
Program of All-Inclusive Care for the Elderly (PACE) - PT(​19)
Psychiatric Distinct Part Unit (DPU) – PT (92)
Psychiatric Hospital - PT (02)
Psychiatric Residential Treatment Facility I - PT (04)
Psychiatric Residential Treatment Facility II - PT (05)
Radiological Services and other Lab and X-Ray - PT (86)
Rehabilitative Distinct Part Unit (DPU) - PT (93)
Renal Dialysis Service - PT (39)
Residential Crisis Stabilization Unit - PT (26)
Rural Health Services - PT (35)
School-Based Health Services - PT (21)
Specialized Children 's Services Clinic or Child Advocacy Centers - PT (13)
Speech-Language Pathologist – PT (79) (799)
Supports For Community Living - PT (33)
Targeted Case Management and Rehab Services provided through Title V Services - PT (23)

Questions

If you can't find the information you need or have additional questions, please direct your inquiries to:
Provider Enrollment or Revalidation - (877) 838-5085
Policy Questions - (502) 564-6890
Waiver Policy Questions - (844) 784-5614
Billing Questions - Gainwell Technologies - (800) 807-1232 - Email billing questions
FFS Gainwell Technologies Provider Representative List - Email Provider Inquiry
Provider Questions - (855) 824-5615
KyHealth.net assistance - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071

Report Fraud and Abuse

(800) 372-2970

Managed Care Forums presentations

Medicaid Provider Complaints
Quality Strategy - It is All in the Numbers
SUD 1115 Demonstration Waiver Update
Provider Enrollment and Partner Portal
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPPP) Overview
Free Care in Schools

Managed Care Organizations

Aetna Better Health of Kentucky 

Anthem Blue Cross and Blue Shield

Humana Healthy Horizons in Kentucky

Passport Health Plan by Molina Healthcare

United Health Care Community Plan

WellCare of Kentucky

Provider Resources

Billing Manual Home
Fee and Rate Schedule Home
Medicaid Assistance Program (MAP) Home
Kentucky Medicaid Provider Directory
Nurse Aid Training Program
Provider Letter Home
Provider Type Summaries
Training and Webinars

Provider Applications

Kentucky Health Net System
Kentucky Medicaid EHR Incentive Program (Promoting Interoperability)
Kentucky Medicaid Management Information System
Kentucky Medicaid Partner Portal
Kentucky Medicaid Waiver Management Application

Open Records Request

DMS currently does not accept open records requests by email. For archive information, please submit an open record request by mail or fax directly to the records custodian listed below.

Open Records Custodian
Dept. for Medicaid Services
275 East Main Street, 6W-C
Frankfort, Kentucky 40601
(502) 564-8196 x2035 (P)
(502) 564-6917 (Fax)

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What's New

Notice of Screening Risk Change for Skilled Nursing Facilities and Hospice Providers

For Skilled Nursing Facilities:

Kentucky Medicaid has been notified of a screening risk level change in 42 C.F.R. § 424.518. for Skilled Nursing Facilities (SNFs) effective Jan. 1, 2023.

As of Jan. 1, 2023, SNFs enrolling or undergoing a change in ownership were elevated from the “limited” level of categorical screening to the “high” screening level. The final rule effectuating this change was published in the Federal Register on Nov. 18, 2022 (87 FR 69404). As a result, any SNF that newly enrolled or underwent a change in ownership/reported a new owner on or after Jan. 1, 2023, is required to be screened at the “high” screening level, resulting in the owner(s) being fingerprinted. Revalidating SNFs (so long as they are not reporting a change in ownership) fall under the “moderate” screening level.
 

For Hospice Providers:


Kentucky Medicaid has been notified that effective Jan. 1, 2024, newly enrolling hospices have been elevated from the “moderate” to the “high” screening level. 

As of Jan. 1, 2024, Hospice providers enrolling or undergoing a change in ownership shall be elevated from the “limited” level of categorical screening to the “high” screening level. The final rule effectuating this change was published in the Federal Register on Nov. 13, 2023 (88 FR 77676​). As a result, any Hospice provider that newly enrolls or undergoes a change in ownership/reported a new owner on or after Jan. 1, 2024, is required to be screened at the “high” screening level, resulting in the owner(s) being fingerprinted. Revalidating Hospice providers (so long as they are not reporting a change in ownership) fall under the “moderate” screening level.

Important Note for All Medicaid Providers about Programs for All-Inclusive Care for the Elderly (PACE) 

PACE​​​​ is now enrolling individuals in Kentucky. When checking eligibility, please determine if the individual is enrolled in PACE. If so, all services must be approved and billing submitted through the individual's PACE organization. 

​Providers asked to report missed or canceled appointments.

KYHealthNet now has a panel for entering missed and canceled appointments. The commonwealth recognizes that when a member misses an appointment or cancels with little notice this is a loss of revenue to your organization and delays another member access to quicker service. We ask you to take a few seconds and provide us information about those missed or canceled appointments so we can act to reduce those cases. Thank you in advance for your help in this effort.

This panel allows you to enter information when a patient either misses or cancels scheduled appointments. If you have any questions about how to enter information on this new panel, please see the User Guide and Video.

Per guidance issued May 21, 2021 Kentucky Medicaid providers are not permitted to charge members for missed or canceled appointments.

Correcting Medicaid Member Incarceration Status Errors

Kentucky Medicaid has a new form providers can use to help members who are incorrectly listed as incarcerated in KYHealthNet. Please review the guidance for reporting incarceration errors and the new MAP-INC form for more information.

Eligibility and Benefits Transaction Saving Opportunities

The Centers for Medicare and Medicaid Services National Standards Group released a new administrative simplification fact sheet detailing potential health care industry time and cost savings from conducting fully electronic eligibility and benefits inquiry and response transactions.

Technical criteria for reviewing Ancillary Services for Adults and Pediatrics

Technical Criteria for Reviewing Ancillary Services for Adults
Technical Criteria for Reviewing Ancillary Services for Pediatrics

Urine Drug Testing Policy

Urine Drug Testing Policy (Effective July 1, 2020)

Cost Report Update

(July 14, 2020) The Centers for Medicare and Medicaid Services authorized the delay of some Medicare cost reports. The KY Department for Medicaid Services also grants the same extension to providers who received an extension approval through CMS or the designated Medicare administrative contractor.

Please call (502) 564-8196 if you have any questions and ask for the staff referenced below based on provider type.

Provider Type​

​DMS Contact

Home Health

​Tara Brewer

Hospital​

​Barb McCarter

​Nursing Facility​

Paulette Greenridge

Kentucky Medicaid COVID-19 Information


Contact Information