License types default based on provider type:

• Providers outside of Kentucky that are NOT issued a license by their state should select Exempt from Licensure from the drop down menu and submit the supporting documentation on screen 8.0.

• Provider Type 31 Primary Care & 35 Rural Health required to upload License Letter from OIG (Office of the Inspector General)

• Provider Type 01 located in OH will not be required to provide License information

• Provider Type 76 located in KY will not be required to provide License information

• Residency Training License begins with R, must upload a letter from Director of the GME (Graduate Medical Education)

• West Virginia must upload both the RN license (“Other “license type) and APRN license (“Health Board” license type)

• Indiana must upload both the RN license (“Other “license type) and the APRN certification (“Health Board” license type) from the American Academy of Nurse Practitioners (AANP) or National Certification Corporation (NCC)

• If Provider Type 74 is selected, the applicant must upload their CRNA State license or national certification

To Add License Information to the Grid:

• Click the Add button

• Click the License Type drop-down and select the License Type

• Click the Issue State drop-down and select the state in which the license is issued

• Enter the Provider’s License Number (displayed on the Provider’s license) in the field

• Additional field of Professional Type displayed for Provider Types 13 (Specialized Children's Services Clinic) and 32 (Family Planning). Select appropriate professional type from the drop-down

• Name on License defaults to Provider Name

• Select the License Designation (Type of license Provider holds) from the drop-down

• Can be entered in the field or selected from the calendar the License Effective Date

• • Temporary License and Permanent license can be overlapping however, there should be no gaps in dates

  • Permanent License date must be same or earlier than the end date of temporary license

• Can be entered in the field or selected from the calendar the License Expiration Date

• • This is the date on which License will expire

  • License Expiration Date cannot be prior to Effective Date

  • One License must be active with Expiration Date in the future

  • The RN License has an expiration date

  • APRN License/certification uses the expiration date of the RN license

  • CRNA License has an expiration date

To View/Change License Information in the Grid:

• Click Add if you wish to add Licenses

• Click the Edit icon in the Action column to change existing record

• Click Discard button to delete record you do not wish to complete

• Click the Remove icon in the Action column to delete existing record

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

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 Expiration Date. If a new record is added to the grid, the active dates of the new record cannot overlap existing record dates.

Substance Use Disorder (SUD) PT 03 Behavioral Health Service Organization (BHSO) Tier Selections and PT 66 Behavioral Health Multi-Specialty Group:  

PT 03:  There are three tiers available for selection:  Tier 1 Mental Health, Tier 2 Outpatient SUD, and Tier 3 Residential SUD.  

PT 66:  No tier selections.  

• PT 03 Tier 1:  BHSO license is required.  Select Health Board as License Type.

• PT 03 Tier 2:  Outpatient Alcohol and Other Drug Entity (AODE) license is required.  Select Health Board as License Type.

• PT 03 Tier 3:  Residential Alcohol and Other Drug Entity (AODE) license is required.  Select Health Board as License Type.

• PT 66:  Outpatient Alcohol and Other Drug Entity (AODE) license required if answered “Yes” to “Are you providing Substance Use Disorder Treatment (SUD)?” on Screen 1.1 Basic Information.

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:

• Residency Training License begins with R, must upload a letter from Director of the GME (Graduate Medical Education) Program; flag for final reviewer

• • Must upload letter with 5 requirements

• West Virginia Provider Type 78 must list both APRN license (“Health Board” license type) and the RN license (“Other” license type)

• • The RN license has an expiration date

  • APRN license uses the expiration date of the RN license

  • Upload of Licenses will occur during Document Upload

• Indiana Provider Type 78 must list both the APRN certification (“Health Board” license type) from the American Academy of Nurse Practitioners (AANP) or National Certification Corporation (NCC) and the RN license (“Other” license type)

• • The RN license has an expiration date

  • APRN certification uses the expiration date of the RN license

  • Upload of Licenses will occur during Document Upload

• If Provider Type 74 is selected, the applicant must enter their CRNA state license or national certification

• • CRNA will select License Type “Health Board”

  • The CRNA license has an expiration date

  • Upload of Licenses will occur during Document Upload

• Certain states do not issue nurse anesthetist licenses. The respective boards will only issue Registered Nurse licenses. It is the responsibility of the RN to get a national certification for their specialty of nurse anesthetist. In this case, applicants must supply their RN license and their national nurse anesthetist license with effective date

• Hospitals in the state of Ohio are not required to provide license information