Go to Kentucky.gov home page
Kentucky Cabinet for Health and Family Services (Banner Imagery) - Go to home page

Provider Revalidation

In an effort to comply with the Affordable Care Act (ACA) requirements per 42 CFR 455 Subpart E, Kentucky Medicaid has implemented changes to provider enrollment policies and procedures.

Under the ACA, Kentucky Medicaid is required to revalidate all providers. The ACA screening criteria apply during revalidation.

Providers should not take any steps to revalidate until they receive a notification letter.

More information and resources about the process, application fee, risk levels and documentation required for revalidation:

Process

Providers will receive notification letters with instructions for revalidating 60 and 30 days before their revalidation deadline. Providers should not take any steps to revalidate until they receive a notification letter. Providers who fail to submit revalidation paperwork in a timely manner will be deactivated from participation in the Kentucky Medicaid Program as of the deadline date.

Providers are required to be revalidated at intervals not to exceed every five years. Providers will be notified when it is time to revalidate their Kentucky Medicaid provider information.

Return to the top of the page.

Application Fee

Certain providers are subject to an application fee. The Provider Type Application Fee Matrix provides a list of provider types subject to the application fee. 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.

CMS sets the application fee amount, which may be adjusted annually. The application fee for 2014 is $542. If you are subject to the fee, please submit a check payable to Kentucky State Treasurer along with the revalidation packet.

If a provider has paid an application fee to Medicare or to another state Medicaid agency, the provider is not required to pay an application fee to Kentucky Medicaid. Please submit proof of payment from Medicare or another state Medicaid agency if the fee has been paid.

Return to the top of the page.

Risk Levels

Providers are categorized by limited, moderate or high risk level. This determination is made by CMS, based on an assessment of potential for fraud, waste and abuse for each provider type.

Providers enrolling, revalidating or changing ownership will be screened according to their assigned risk level.

General screening activities required for each risk category:

Risk Level Screening Activities

Limited

  • Verification of provider-specific requirements, including but not limited to the following:
  1. License verification
  2. National Provider Identifier check
  3. Database Exclusion Check

Provider types not listed in the moderate or high categories below are in the limited category.

Moderate
  • Unannounced site visits before and after revalidation
  • Verification of provider-specific requirements, including but not limited to:
    1. License verification
    2. National Provider Identifier check
    3. Database Exclusion Check

Providers in the moderate category

  • PT 30- Community Mental Health Center
  • PT 44- Hospice
  • PT 55- Emergency
  • PT 56- Specialty 661 only (Ambulance)
  • PT 86- Other Lab/X-ray
  • PT 87- Physical Therapist
  • PT 91- Comprehensive Outpatient Rehabilitation Facility
High
  • Fingerprinting and criminal background check for all individuals with 5 percent or greater ownership in the entity (implementation pending)
  • Unannounced site visits before and after revalidation
  • Verification of provider-specific requirements, including but not limited to:
    1. License verification
    2. National Provider Identifier check
    3. Database Exclusion Check

Providers in the high category

  • PT 34- Home Health
  • PT 37- Independent Laboratory
  • PT 90- Durable Medical Equipment (DME)

Return to the top of the page.

Documentation required for Revalidation
  1. Map-811 for Revalidation or MAP-900(Revalidation)
  2. License
  3. NPI/Taxonomy Code Verification
  4. Medicare Participation Verification (if applicable per provider type summary for your provider type.)
  5. DME Accreditation (Provider Type 90 only)
  6. JCAHO Accreditation (Provider Types 01, 02, 04, 92 and 93 only)
  7. CLIA Certification (If applicable per provider type summary for your provider type.)
  8. Social Security card (required for individual providers revalidating. If applicant has as social security card stating valid for work only with DHS/INS Authorization. Additional requirements Social Security Cards marked not valid for employment will not be accepted.
  9. IRS Verification of FEIN - If applicant is sole owner of a tax ID, please submit IRS letter of verification of FEIN or official IRS documentation stating FEIN. FEIN must be pre-printed by IRS on documentation. Form W-9 will not be accepted.
  10. Application Fee if applicable to the provider type or submit proof of payment from Medicare or another state Medicaid agency.

Return to the top of the page.

Revalidation Frequently Asked Questions

 

Regulations, Resources
   

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. Eastern time

Email

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

 

Last Updated 6/27/2014
Privacy | Security | Disclaimer | Accessibility Statement