Per 42 CFR 455.460, certain providers are subject to an application fee for Initial Enrollment and Revalidation. Generally, the application fee applies to institutional providers as defined by Centers for Medicare and Medicaid Services (CMS) and not to individual professionals, such as physicians.
Below are the provider types that are subject to this fee:
- Hospital (01)
- Skilled Nursing Facility (12)
- Community Mental Health Center (30)
- Federally Qualified Health Center (31)
- Home Health Agency (34)
- Rural Health Clinic (35)
- Ambulatory Surgical Center (36)
- Independent Clinical Laboratory (37)
- End-Stage Renal Disease Facility (39)
- Hospice (44)
- Ambulance Service Supplier (55)
- Portable X-Ray Supplier (86)
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (90)
- Comprehensive Outpatient Rehabilitation Facility (91)
CMS sets the application fee amount, which may be adjusted annually. The application fee for 2017 is $560. If you are subject to the fee, please submit a check payable to Kentucky State Treasurer along with the enrollment or revalidation packet. For more information, please see the Federal Register notice.
Providers having paid an application fee to Medicare or to another state agency will not be required to make payment. KY Medicaid Provider Enrollment verifies proof of payment during the enrollment and revalidation process
Fingerprint-based Criminal Background Check (FCBC) - Helpful Information
KY Medicaid providers considered “high” risk according to the provisions of 42 CFR 455.434 recently received a letter indicating the requirement to comply with Fingerprint-based Criminal Background Check (FCBC).
“High” risk can apply to individual or organizational providers and is defined by two federal regulations, 42 CFR 424.518(c) and 455.450(e). Providers in this category include
- Home Health Agencies (HHAs);
- Durable Medical Equipment suppliers (DMEs);
- Providers excluded by HHS/OIG or another state’s Medicaid Program within the previous ten (10) years;
- Providers that have been on a payment suspension at some time in the last 10 years; and/or
- Providers that upon enrollment or revalidation are found to have an outstanding overpayment of $1500 or more owed to DMS. This does not apply to providers with an overpayment under appeal, in a payment plan or on hold.
Further, a person with five (5) percent or more direct or indirect ownership in a “high” risk provider are required to undergo a national (FCBC).
Letters were processed to be sent at the end of May 2017, but many did not get posted until mid-June. Providers receiving their notices late are requested to comply with the FCBC requirement within 30 days of receipt of their letter.
Please note that some providers with an established accounts receivable were sent the FCBC letter in error. Those providers will be receiving a letter to rescind the FCBC requirement. KY Medicaid has called or emailed the providers affected by the erroneous notice.
Please contact Provider Enrollment at (877) 838-5085 if you have any questions. Thank you for your attention.
As of Apr. 1, 2017, only the MAP- 811 (Enrollment)( Rev. Jan 2017) and the MAP-900 (Revalidation) (Rev. Jan. 2017) will be accepted.
Beginning Nov. 1, 2016, when adding, updating or changing the NPI, taxonomy or both, the effective date of the change will be the day it is received by DMS or a future/prospective date requested by the provider.
Providers may now start the process to enroll as a PT 48 - Home Delivered Meals with an effective date of Sept. 15, 2016. If you have any questions about the requirements to be a home-delivered meal provider, please contact the Department for Aging and Independent Living at (877) 315-0589.
You may begin enrolling on Aug. 1, 2016 as a LPT-67 - Licensed Clinical Alcohol and Drug Counselors (LCADC) limited to services provided in a CMHC, CDTC, Level I/II PRTF, Outpatient Hospital and Outpatient Psych Hospital. The information provided for the provider type is subject to change pending future amendments to or adoption of state regulations. If you have any questions about the process, contact the Department for Medicaid Services at (502) 564-7450. If you have any questions regarding enrollment, please contact Provider Enrollment at (877) 838-5085.
(May 24, 2016) - Please see the updated information below regarding changes to the MAP-347 and the MAP-529. Please note this change will apply to new submissions of these forms beginning June 1, 2016.
MAP-347, the Statement for Authorization of Payment, Group Linkage Section form has been updated. The old form will be accepted up to May 31, 2016. Beginning June 1, 2016, the new MAP-347 will be required. Any MAP-347 submitted after May 31, 2016 on the old form will be returned for updating. The distinguishing factor to recognize you are using the correct form is [MAP-347, Rev. May 2016] in the top left corner of the form.
MAP-529, KY Medicaid Change of Information Form has been updated. The old form will be accepted up to May 31, 2016. Beginning June 1, 2106, the new MAP-529 will be required. Any MAP-529 submitted after May 31, 2016 on the old form will be returned for updating. The distinguishing factor to recognize you are using the correct form is [MAP-529, Rev. May 2016] in the top left corner of the form.
If you have any questions, please either email or call us at 1 (877) 838-5085.
Attention Providers: Correction to notice regarding revalidation
(May 6, 2016) - The notice sent recently regarding Kentucky Medicaid no longer accepting the Medicare revalidation letter contained information that may be confusing to providers. Only providers who receive a letter from Medicaid regarding their revalidation may be subject to termination if they do not submit a MAP-900. Providers do not need to submit a MAP-900 until they are notified by letter to revalidate, which occurs every five years. Providers can check their revalidation date by logging into KYHealthNet. Medicaid sends a 60-day and 30-day letter prior to the due date.
We regret the confusion. If you have any questions, please send us an email or call 1 (877) 838-5085.
(Mar. 17, 2016) - Provider type 76 - Multi-Therapy Agency, is anticipated to be effective in June, 2016. Providers may begin submitting applications to enroll in Medicaid as this provider type on May 15, 2016 but applications will be held and will not be processed until state regulations are final. The information provided for this provider type is subject to change pending adoption of state regulations.
For more information about the new therapy process, please read the
If you have questions about the therapy process, contact the Department of Medicaid Services at 502-564-7540. If you have any questions regarding enrollment after May 15, 2016, please contact Provider Enrollment at 1-877-838-5085.
(Dec. 16, 2015) - The new 2016 application fee is $554. For more information, please see the Federal Register notice.
(May 28, 2015) - Starting July 1 providers no longer will be required to file an Annual Disclosure of Ownership (ADO). Therefore, any provider who has a due date of July 1st and thereafter is not required to submit an ADO. Only those providers with a due date up to and including June 30 are required to submit an ADO.
Medicaid was updating its system to prevent the 60-day and 30-day notice letters from going out to providers with a due date starting July 1, but it did not take effect in time. Therefore, providers may receive letters erroneously.
If a provider has a due date of July 1 and thereafter, please disregard any letters requiring the ADO. However, please do not ignore other correspondence from us including revalidation notices.
Attention Providers - MAP 811 form launch delayed
(May 5, 2015) - An April 26, 2015, letter sent to providers regarding 2015 legislative changes to provider enrollment included the statement, "In addition, effective May 1, 2015, all applications must be submitted on the revised MAP-811 in order to be processed. Otherwise, the application will be returned."
Due to technical difficulties launching the new MAP-811 form, DMS advises providers this change will not take effect until July 1, 2015. You may submit either version of the MAP 811 application until July 1, 2015.
Attention Providers - Important 2015 General Assembly Legislative Changes to the Provider Enrollment Program.
(April 21, 2015) - Thank you for participating as a provider in the Medical Assistance Program. The Department for Medicaid Services is working continuously to improve provider participation and streamline processes and is pleased to inform you of two important changes to KY Medicaid enrollment requirements resulting from legislation passed during the 2015 General Assembly. Read the general provider letter regarding 2015 legislative changes to provider enrollment
Attention Providers - Disabling the Electronic Funds Transfer
(Feb. 18, 2015) - The Electronic Funds Transfer (EFT) update function via KY Health Net will be disabled on March 6, 2015. In order to update your EFT, please contact provider enrollment at 877-838-5085 for further instructions. We apologize for any inconvenience.
Attention Providers - Disabling the EADO Process
(Jan. 23, 2015) - The Electronic Annual Disclosure of Ownership (EADO) process has been disabled. This functionality may be available in the future. If you have an EADO currently in process, you may be contacted for further information if additional information is needed to process your EADO. We apologize for any inconvenience.