To de-link an individual provider from an existing group, click Edit and add Provider Linkage End Date.
To Link to a Group:
Select Add
Enter the Group Medicaid ID #
Enter the Group Federal Employer Identification Number (FEIN)
The Group Medicaid ID and FEIN will be validated once the information has been added to the grid
Enter the Group Linkage Effective Date
Group Linkage Effective Date is the date the affiliation with the Group is effective.
Group Linkage Effective Date may not be more than 1 year in the past (Active or Inactive Group).
The Requested Group Linkage Effective Date must fall within the Group Medicaid ID’s effective dates
Select Verify Group Name
Group Name should be entered exactly as shown by the Group
Select Group Linkage Expiration Date (not a required field)
Select Add to Grid
Select Edit to change the linkage of a Group
Select Remove to delete linkage to a Group
Expiration Date:
In KY MPPA, some records cannot be deleted. To add a new record, the previous record must have an Expiration Date added in order to keep the history on file. To add an Expiration Date to a record, click the "Edit" button and add an End Date. If a new record is added to the grid, the active dates of the new record cannot overlap existing record dates.
Required Fields
Please note that all fields marked with an asterisk (*) are required fields that must be populated in order to move forward. If they are left blank you will receive an error message.
Special Characters:
The following Special Characters cannot be used in the situations below. Field properties will not allow the following characters in the box:
For First Name, Business Name, Other name (if any): | + \ '
For Last Name field: | + \ ', and numbers are not allowed
For Comment Boxes: < > ^ ~ ` + | \ / ¬ £
For Address fields: | + ! @ # $ ^ * ( ) ? / \ " < > & : ; _
If you copy and paste an excluded special character, an error message will display after clicking Save & Next
Remove excluded characters from pasted information or uploaded text in the document
Save & Next:
When finished, click Save & Next to save the information and proceed to the next page
Click Back to go to the previous screen without saving
Click Exit to return to the dashboard without saving
Note that if the information is not saved, you will lose the data on the current page
Additional Notes:
Provider Type 20 (Preventive and Remedial Public Health Services) should default and always be linked to KY Medicaid Provider Number 20901211. This provider type cannot link to any other group or entity.
Group Medicaid ID and Group FEIN will be validated at Add to Grid. If the combination of Medicaid ID and Group FEIN is not found, a message will be provided.
When a Group is end dated, all the linkage of all individuals to that group will be end dated. No notification will be sent to the individual group members.
Groups do not have to approve an Individual Provider’s linkage. Use of Group Medicaid ID and Group FEIN is sufficient.
An acceptable provider linking cross reference chart of acceptable providers may be found here: http://www.chfs.ky.gov/NR/rdonlyres/68315B79-7EE3-4345-94E5-BF170EA8679F/0/Map347Grouplinkagesrevised07072015.pdf