Medicaid ID

• Enter the KY Medicaid ID for which you need to perform maintenance or revalidation. Once the ID is entered, click Search.

Provider Name

• The name of the Provider, Group, or Entity will appear on the screen. These fields cannot be edited.

 NPI (National Provider Identifier)

• NPI is a unique identifier that is assigned in National Plan and Provider Enumeration System (NPPES). See the National Provider Identifier information page for more information.

• The NPI that displays on the Maintenance screen will be the NPI number that is associated with this specific KY Medicaid ID.

• Not all Provider Types will have a NPI and this field will not be displayed for those Provider Types.

• Additional NPIs can be added in a later section of Partner Portal or during maintenance after a Provider Medicaid ID is assigned.

Taxonomy

• The Taxonomy/Taxonomies is associated with this KY Medicaid ID.

• Not all Provider Types will have NPIs and Taxonomies.  This field will not be displayed for those Provider Types.

• A Provider may have multiple taxonomies but only one is identified as Primary for this enrollment.

Primary Physical Address

• ·         This address is associated with this KY Medicaid ID.  The primary address can be changed on screen 1.7: Address Information.

Revalidation Date

• This pre-populated field displays the date of revalidation for this KY Medicaid ID.

Medicaid ID Effective Date

• This is the date of approval for this Medicaid ID.

Medicaid ID End Date

• This is the date of expiration for this Medicaid ID.

Requested Effective Date

• Date cannot be more than 1 year prior than the current date nor greater than 90 days in the future.

• For Voluntary Termination: Requested Effective Date must be a current date or greater than current date (Backdating not allowed). Date is permitted up to 90 days or Medicaid ID End Date, whichever comes first. Requested Effective Date must be equal to or greater than Medicaid ID Effective Date but less than or equal to Medicaid ID End Date or up to 90 days in future, whichever comes first.

• Provider’s supporting documents must be effective on the Requested Effective Date.

I Want to Perform

• There are five options available for KY MPPA users. Select the applicable path.

• • Maintenance

  • Revalidation

  • Voluntary Termination

  • Reinstatement

  • Reapplication

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

Continue:

• When finished, click Continue to save the information and proceed to the next page

• 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