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Who We Are

​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 FAQs

​It generally takes 60 to 90 days from receipt of a correct application.

​The enrollment process must begin again if errors are made on the enrollment application. It will take another 60 to 90 days to receive a provider number. Please review the application for completeness or missing documentation before submitting it.

​Be sure your application is complete and accurate. Do not omit any information requested and provide a response in each form field. Even if something requested does not apply, please write in "N/A." Be sure all required provider type documentation is attached. If enrolling an individual provider (e.g. physician, dentist, nurse practitioner, etc), attach the enrollee's license and Social Security card. If enrolling a group, attach IRS documentation and any documents that pertain to that group.

If you have problems with the application, contact your MCO program or a provider services representative at (877) 838-5085. Representatives can answer your questions about the application over the phone to help you complete your application correctly. To verify which forms you need, refer to the Provider Type Summaries.

​No, since all documentation must be imaged prior to being processed, all mail must be sent to DXC.

Faxing documentation to DMS will not only delay the processing, but this could also cause the documentation to not get processed at all.

​You will send the application to the MCO of your choice. Please refer to the Managed Care Organization Information tab on our website or contact the MCO of your choice directly at the phone numbers listed below.

​You can contact the MCO program in which you submitted the application to or you may contact provider services at KY Medicaid at (877) 838-5085.

​If you wish to send any documentation to update your files or maintain your files, such as a MAP-529 (change of information form), license, etc.,

Please mail the document to:
Provider Enrollment
PO Box 2110
Frankfort, KY, 40602

If you wish to send the document to a physical address, please mail to: 
DXC
Attn: Provider Enrollment
656 Chamberlin Drive
Frankfort, KY 40601

Do not mail any documents or applications directly to DMS. Mailing to DMS will not only delay the processing time, but there is no guarantee the document will be delivered to the correct area for processing. Please write your KY Medicaid provider ID number on each document before submitting the document.

​Once a final decision has been made, KY Medicaid will notify you via email, fax or mail.


​Note: For any MCO's you are enrolled with, you may need to contact them of the change as well.

First, refer to our provider type summaries page. If you are an individual provider who requires to be enrolled in Medicare primary, please complete a MAP-529 - Kentucky Medicaid Change Information Form and attach verification from Medicare, if applicable, of the address change with Medicare. If you are changing location to a different state, please attach a copy of the license for the state you will be practicing in with the MAP-529 form.

​Note: For any MCO's you are enrolled with, you may need to contact them of the change as well.

First, please refer to our Provider Type Summaries. If you are an entity who requires to be licensed (such as a hospital, independent Laboratory, etc.,) you will need to enroll each location separately. Or if you are an entity such as a physician group that is opening additional locations in the same state, and you have a CLIA certificate, you must enroll each location separately. If you are an entity in different states, each state would have to enroll separately whether there is a CLIA certificate involved or not.

  • ​If you are an individual provider , submit a written request, signed by you the individual provider, on letterhead along with your Social Security Number, NPI# and your signature. If you would like the request be emailed to you, please provide an email on the request. If you would prefer the request be faxed to you, provide that information on the request as well, and mail the request to:
    KY Medicaid
    P.O.Box 2110
    Frankfort, KY 40602
  • If you are an entity and would like the KY Medicaid provider number sent to you, please submit a written request with your FEIN number, NPI number, and physical location on company letterhead. The letter must be signed by an owner, officer or board member along with their title. Submit the request to:
    KY Medicaid
    P.O. Box 2110
    Frankfort, KY 40602

Agency News

Revised Forms

Update: CMS requires the collection of whether a hospital (PT 01) and a psychiatric hospital (02) is a Teaching Facility, which refers to a hospital engaged in an approved GME residency program in medicine, osteopathy, dentistry, or podiatry. As such, KY DMS has revised the MAP-811 (New Enrollment) and the MAP-900 -(Revalidation) to capture this information. 

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's 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 (KOG); for these provider types, this is the preferred email.

Ordering, Referring and Prescribing Provider Information

A General Provider Letter - Ordering, Referring and Prescribing Providers (PDF) and FAQ document (PDF) was mailed to a provider on Feb. 1, 2017 regarding ordering, referring and prescribing providers enrolling as Medicaid providers.

Questions regarding this notice may be directed to DMS Provider Services at (855) 824-5615, Monday through Friday, 8 a.m. to 5:30 p.m. Eastern time.

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.

Below are the provider types that are 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 2018 is $569. If you are subject to the fee, please submit a check payable to Kentucky State Treasurer along with the enrollment or revalidation packet. For more information, please see the Federal Register notice.

Providers having 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

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 (HHAs);
  • Durable Medical Equipment suppliers (DMEs);
  • Providers excluded by HHS/OIG or another state’s Medicaid Program within the previous ten (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 (5) 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 an 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. Thank you for your attention.

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