​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 before receiving a notification letter.

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 have their participation in the Kentucky Medicaid Program suspended.

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.

Documentation Required for Revalidation

1. MAP-900 (Revalidation (rev. Aug 2018) New
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.

Application Fee

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 revalidation packet.

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.

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: