What's New
Off-Cycle Revalidations
The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), has directed Kentucky Medicaid to complete off-cycle provider revalidations over the next 24 months. The goal of this off-cycle revalidation is to ensure the accuracy of provider enrollment data and confirm that only legitimate, qualified providers are enrolled and participating.
Kentucky Medicaid will focus on providers that have not revalidated in the last 12 months. Kentucky Medicaid will prioritize the review of identified providers in the following order:
- High Risk
- Atypical (Providers with no NPI)
- First Moderate Risk, then Limited Risk
- Moderate Risk
- Limited Risk
Providers identified in any of these categories will be notified of their off-cycle revalidation requirement via notification from the Medicaid Partner Portal Application (MPPA) and will receive a revalidation letter outlining the action they need to take. These providers will need to submit a revalidation in MPPA, even if they revalidated in the last four years.
Due to the 24-month deadline to complete this off-cycle revalidation, providers must complete their revalidation and submit it as soon as they receive their notification/ letter. This will allow Kentucky Medicaid time to review and process these revalidations promptly, prevent provider billing issues, and meet the required deadline. Any updates that need to be made to a provider file can be included in the revalidation instead of submitting a separate maintenance. The following resources include more information about the process.
Understanding Kentucky Medicaid's Provider Revalidation Process
Off-Cycle Revalidations Presentation
Thank you for your cooperation and assistance in this matter.
Kentucky Managed Care Plans Prior Authorizations (PA): The revised Kentucky Managed Care Plans Prior Authorization by Behavioral Health Service Comparison (PDF) is now available.
Community Health Workers: Learn more about Community Health Workers (CHW) and which provider types can bill for their services.
CHW Presentation (PDF)
CHW Frequently Asked Questions (PDF)