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Kentucky Medicaid
Kentucky Medicaid, answered on time and paid
An active Kentucky Medicaid provider number, deficiency notices answered in time, and recredentialing on the calendar.
Kentucky Medicaid enrollment pays off when every notice from the department is answered inside its deadline, because an applicant who does not respond in time is denied. The rules sit in 907 KAR 1:672 and 907 KAR 1:671.
Notice of missing information
Within 45 days of receiving a required credentialing form, the department must notify the applicant of any omitted or questionable information. 907 KAR 1:672, Provider enrollment, disclosure, and documentation
Answer or be denied
Enrollment is denied if the applicant does not respond with the requested information within the time period in the department's notice. 907 KAR 1:672, Provider enrollment, disclosure, and documentation
Decision timeline
The department must make an enrollment determination within 90 days of receiving the completed application documents and any additional information it requested. 907 KAR 1:672, Provider enrollment, disclosure, and documentation
Recredentialing
A credentialed provider must go through recredentialing three years from the initial evaluation or last reevaluation. 907 KAR 1:672, Provider enrollment, disclosure, and documentation
What we see in practice
45 to 90 days from submission to an active Medicaid ID.
In the official words
…in the Medicaid Program shall be enrolled as a participating provider prior to being eligible to receive reimbursement
…within thirty-five (35) days of the department's written request, the department shall terminate the provider's participation in the Medicaid Program
Answering the state's notice on time keeps the file alive
Kentucky's rule works on a clock. Within 45 days of receiving a required credentialing form, the Department for Medicaid Services must tell the applicant about any omitted or questionable information. The department must then deny enrollment if the applicant does not respond with the requested information within the time period in that notice. 907 KAR 1:672
An extension is possible, but it has to be requested during the time period in the notice and granted by the department. 907 KAR 1:672
How enrollment works, step by step
- Know your category. Dentists, physicians, audiologists, certified registered nurse anesthetists, optometrists, advanced registered nurse practitioners, podiatrists, chiropractors and physician assistants are credentialed providers. 907 KAR 1:672
- Complete the individual section of the MAP 811 Provider Application and send proof of a valid professional license, registration or certificate for your scope of practice. 907 KAR 1:672
- Add the credentialing form. Except for a dentist, that is either the Kentucky Application for Provider Evaluation and Reevaluation or the provider application form of the Council for Affordable Quality Healthcare. A dentist submits the Dental Credentialing Form. 907 KAR 1:672
- Answer any notice of omitted or questionable information inside the time period it gives. 907 KAR 1:672
- Expect a determination within 90 days of the completed application documents and any additional information the department requested. The department may take longer to resolve an issue or dispute, and must notify you that the decision will come after the 90 days. 907 KAR 1:672
- On approval, the department issues a provider number for billing and identification, and participation begins and ends on the dates in the approval notice. 907 KAR 1:672
Under 907 KAR 1:672 the Department for Medicaid Services has 45 days to tell you what is omitted or questionable, and a determination is due within 90 days of the completed documents and anything it asked for, with more time allowed when the department notifies you. Our own planning figure is 45 to 90 days from submission to an active Medicaid ID.
Site visits, disclosures and recredentialing
The department may require an onsite inspection to ascertain compliance with licensure standards and certification standards, prior to an enrollment determination. 907 KAR 1:672
Disclosure of ownership and control information is due upon application, annually after that, and within 35 days of a written request from the department. A signed amended ownership and disclosure form is due within 35 days of a change in ownership or control, the managing employee or management company, or the federal tax identification number. 907 KAR 1:672
Recredentialing comes three years from the initial evaluation or the last reevaluation for a credentialed provider. 907 KAR 1:672
Where Kentucky enrollments lose money
A denial takes effect on the date of the written notice, and the department will consider reapplication only if the applicant corrects each deficiency that led to the denial. 907 KAR 1:672
The 35 day deadlines are the quiet ones. If a provider does not disclose the required information within 35 days of the department's written request, the department must terminate its participation. Failing to keep information up to date, or to submit it within 35 calendar days of a request, also results in termination. 907 KAR 1:672 907 KAR 1:671
Check where you stand before you submit
WeBill Health runs Revenue Velocity Credentialing with 24/7 CAQH and PECOS lifecycle monitoring, so revalidation dates and affiliation gaps are caught before they become suspended claims. Every file gets Human Expert Review from a credentialing specialist before it goes to the state.
Revenue Velocity Credentialing
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The Revenue Defense Audit is a free, forensic review of your claims and A/R by the team that would work your account, including providers seeing patients under a payer that cannot pay them yet.
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