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Thank you for your interest in becoming a KY Medicaid Provider. Enrollment in the program is not guaranteed; therefore, providing services to Kentucky Medicaid members prior to your effective date is at your own financial risk.

The Department for Medicaid Services (DMS) only contracts with providers or entities qualified under 907 KAR 160; 1:671 and 907 KAR 1:672 and approved by DMS to participate. DMS reserves the right to approve or reject a contract with any prospective provider.

Notice: Pursuant to 907 KAR 1:672 Section 2 1(c)(1), you must be enrolled as a participating provider prior to being eligible to receive reimbursement.

Enroll as a Medicaid Provider

If you are not assigned to an MCO or choose not to participate in a MCO, (fee-for-service provider) and to become a Kentucky Medicaid provider, you must complete and submit the MAP 811 (Enrollment) Provider application and supporting documentation. To verify which forms you need, refer to Provider Type Summaries and Forms.

Once you completed and signed your forms, send them to:

Kentucky Medicaid
Provider Enrollment
P.O. Box 2110
Frankfort, KY 40602

If you would like to request participation in a MCO, please refer to one or all of the MCO websites listed below:

If you would like to request participation as an Aetna Better Health provider, visit the website or call 1-855-300-5528

If you would like to request participation as an Anthem provider, visit the website or call 1-800-205-5870

If you would like to request participation as a Humana-CareSource provider, visit the website, contact by email or call 1-800-457-5683

If you would like to request participation as a Passport provider, submit completed, signed forms to: 5100 Commerce Crossings Drive; Louisville, Kentucky 40229 or call (800) 578-0775. Note: If you are requesting participation as a Passport MCNA provider, please contact Sophia Wallen at (877) 375-6262 extension 103 to obtain a dental credentialing packet.

If you would like to request participation as a Wellcare of Kentucky provider, visit the website or call 1-877-339-9457.

How long will the enrollment process take?

The enrollment process may take up to 90 days or longer if the documentation or information is not complete or correct. Also, if there are any outstanding accounts receivable, you will need to satisfy those debts before the application can be approved.