How to become a Medicaid provider in Kentucky
To bill Kentucky Medicaid, enroll through Kentucky Medicaid Partner Portal Application (MPPA), run by Gainwell Technologies. The process has 5 steps, listed below with the documents the state asks for.
- Enrollment portal
- Kentucky Medicaid Partner Portal Application (MPPA)
- Steps
- 5
- Documents
- 6
- Plans listed
- 5
On this page
Kentucky Medicaid enrollment at a glance
To bill Kentucky Medicaid, enroll through Kentucky Medicaid Partner Portal Application (MPPA), run by Gainwell Technologies. The process has 5 steps, listed below with the documents the state asks for.
- Program
- Kentucky Medicaid (Department for Medicaid Services)
- Enrollment portal
- Kentucky Medicaid Partner Portal Application (MPPA)
- Fiscal agent
- Gainwell Technologies (fiscal agent for KY Medicaid claim processing, KYHealth-Net)
- Application fee
- Kentucky's MAP-811 checklist tells providers subject to the fee to attach a check payable to the Kentucky State Treasurer; DMS's provider-type summaries say which types owe it. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.
- Fingerprinting
- Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.
- Site visit
- Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.
- Revalidation
- Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.
- Provider manual
- Provider manual
Steps
- Check the DMS provider-type summary for enrollment requirements and fees
- Fee-for-service-only providers apply online in the Kentucky Medicaid Partner Portal Application (MPPA)
- Providers joining an MCO may send the Medicaid enrollment packet (MAP-811 and documents) to one MCO together with that MCO's contracting and credentialing application
- Attach licenses/certifications, NPI and taxonomy verification, SSN card or IRS FEIN letter, MAP-347 group linkage if needed, and the fee check if required
- DMS must enroll a provider within 60 days of a clean application (time paused for federal screening); the full process can take up to 90 days
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- Under KRS 205.532 (contracts from June 29, 2023), every Medicaid MCO contract must require one of two things: a DMS-recognized credentialing alliance using a single NCQA-accredited CVO and one web-based credentialing application for all MCOs (30-day turnaround on clean applications), or, if no alliance was recognized by December 31, 2023, a single CVO picked by DMS through an RFP for all MCOs. Providers still request participation from each MCO separately. Centralized credentialing: yes by statute (single CVO/single application); we could not confirm from the sources which model DMS put in place.
- Plans (state list)
- Aetna Better Health of Kentucky
- Humana Healthy Horizons in Kentucky
- Passport by Molina Healthcare
- UnitedHealthcare Community Plan
- Wellcare of Kentucky
Frequently asked questions
How do I become a Medicaid provider in Kentucky?
To bill Kentucky Medicaid, enroll through Kentucky Medicaid Partner Portal Application (MPPA), run by Gainwell Technologies. The process has 5 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in Kentucky Medicaid?
Kentucky's MAP-811 checklist tells providers subject to the fee to attach a check payable to the Kentucky State Treasurer; DMS's provider-type summaries say which types owe it. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.
How often must Kentucky Medicaid providers revalidate?
Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.