Provider Type Summaries
Please select the provider type from the list below for application information.
If you have any questions on the information provided for the provider types below, contact Provider Enrollment from 8 a.m. - 4:30 p.m. Eastern time Monday through Friday at 877-838-5085.
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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.
(March 17, 2016) - Provider type 76 - Multi-Therapy Agency is expected 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 not 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.
||Current Provider Number and Type