Provider Application Information

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 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 want to enroll as a Kentucky Medicaid provider and are not assigned to an MCO or choose not to participate in an MCO (fee-for-service provider),  you must submit an application online using the Kentucky Medicaid Partner Portal

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 provider, visit the website or call 1 (800) 444-9137.

If you would like to request participation as a Passport provider, submit completed, signed forms to:
5100 Commerce Crossings Drive
Louisville, Ky. 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, ext. 103 to request 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 documentation or information is not complete or correct. If there are any outstanding accounts receivable, those debts must be satisfied before the application can be approved.