Kentucky Application Service Provider Agreement
Description
How to fill out Application Service Provider Agreement?
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FAQ
Apply for Medicaid Apply for traditional Medicaid only by calling the Kentucky Healthcare Customer Service line toll-free at (855) 459-6328 or contacting an application assister through the Kentucky Health Benefit Exchange website.
Behavioral Health Service Organizations (BHSO) - PT 03 - Cabinet for Health and Family Services.
The KY Department for Medicaid Services also grants the same extension to providers who received an extension approval through CMS or the designated Medicare administrative contractor. Please call (502) 564-8196 if you have any questions and ask for the staff referenced below based on provider type.
To enroll in Kentucky Medicaid, please go to the Medicaid Provider Portal Application (MPPA). Providers who are not participating need to request a contract by completing the provider nomination form. Once completed please return to KYProviderUpdates@Aetna.com.
Enrolling New Kentucky Medicaid Providers Review the provider type summary for your provider type to understand the documentation required to enroll. Review the training resources to help navigate the KY MPPA. Download multifactor authentication software. Create an account and start an application on the KY MPPA.
Enroll as a Medicaid Provider If you would like to request participation as an Anthem provider, visit the website or call 1 (800) 205-5870. If you would like to request participation as a Humana provider, visit the website or call 1 (800) 444-9137.
Apply for Medicaid Apply for traditional Medicaid only by calling the Kentucky Healthcare Customer Service line toll-free at (855) 459-6328 or contacting an application assister through the Kentucky Health Benefit Exchange website.
As of July 1, 2021, MedImpact is the pharmacy benefits manager for all Kentucky health plans offering coverage to Medicaid enrollees. As a result, MedImpact manages all prior authorization requests for medications. To submit a prior authorization request to MedImpact: Call 844-336-2676.