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Get KY Map-811 2017-2024

Declare “I am enrolling as a reinstatement” by checking fourth block. MCO Participation: If you will be participating with a KY Managed Care Organization (MCO), please indicate. Field # Description 1 2 If a Kentucky Medicaid provider number has already been assigned to this provider, enter provider number. Please mark the appropriate box. Indicate name of individual provider or if an entity/group is enrolling, please input entity/group name. For individual applicants, the name referenced.

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