Get Ky Map-900 2018-2025

The KY MAP-900 form is essential for providers looking to enroll in the Kentucky Medicaid Program or revalidate their existing participation. This guide will walk you through the specific components of the form and provide clear instructions for completing it online.

Follow the steps to fill out the KY MAP-900 online successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This will allow you to access the KY MAP-900 for filling out your details.
2. Read through the instructions carefully. Ensure you understand all the fields and requirements outlined, particularly those that are mandatory.
3. Begin with Section A: Administrative Information. Enter the Kentucky Medicaid provider number that you are revalidating.
4. Mark the appropriate box for whether you are enrolling as an individual or an entity/group, and clearly input the name as required.
5. Provide the 'Doing Business As' name if it differs from the official name entered previously. Include the email address for the provider or owner.
6. Complete all sections related to license/certification numbers, provider type, and types of service provided.
7. Fill in your National Provider Identifier (NPI) and Taxonomy Code(s). This information can typically be obtained from the National Plan and Provider Enumeration System (NPPES).
8. Attach any required documents, including your Social Security card, IRS verification letter, and any relevant licenses to your application.
9. Review Section B for required information regarding ownership and control interest. Complete each question with accurate and truthful details.
10. Finally, review all filled information for accuracy, sign and date the signature page. Remember that electronic or stamped signatures are not permitted.
11. Save your completed form, then download or print it as needed for your records. Ensure you keep a copy before submission.
12. Submit the application to the designated address for Kentucky Medicaid as specified in the guidelines.

Complete your KY MAP-900 document online today to ensure a swift and efficient enrollment process.