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Thank you for participating in the Kentucky Medicaid Program. The Kentucky Medicaid Program appreciates your interest and welcomes the opportunity to work with you to provide health care services to Kentucky Medicaid members.

Provider News

From the Kentucky Department for Medicaid Services (KY DMS):
Dentists enrolled as Kentucky Medicaid providers with Kentucky Board of Dentistry (KBD) license due to expire Dec. 31, 2019:

  • Please update your license with KBD at least 15 days prior to the expiration date, no later than Dec. 16, 2019.
  • KBD is working with KY DMS to transmit updated license information electronically.

A copy of your KBD license no longer will be required by DMS until revalidation or maintenance is necessary.

Providers not updating their license with the KBD at least 15 working days prior to the expiration date and no later than Dec. 17 must submit their updated license to DMS through the Kentucky Medicaid Partner Portal Application (KY-MPPA log in) to update their provider file.

Note: Providers with out-of-state licenses must submit updated license information through the KY MPPA.

Revised Forms

Update: KY DMS has revised the MAP-811 New Enrollment) and the MAP-900 -(Revalidation) to capture telehealth information effective June 1, 2019.

Application Information

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.

Provider types 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 2019 is $586. Please submit a check payable to Kentucky State Treasurer along with the enrollment or revalidation packet.

Providers who have 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.

Provider Update

KY DMS is implementing a new enrollment system, which requires a provider's email address. This email address will be connected to the provider KY Medicaid number (existing and newly issued), and is required to secure accounts. The email address used cannot be the credentialing contact email address, only the provider's.

Prescribing providers already have an email address they use for KASPER through KY Online Gateway. For these provider types, this is the preferred email.

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
  • Durable Medical Equipment suppliers
  • Providers excluded by HHS/OIG or another state’s Medicaid Program within the previous 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 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 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.

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