Applying As (Category):

• Individual – A provider working as self

• Group – A business that contains one or more providers of the same Provider Type. All fields relate to the group business and not to an individual. When the application is processed and approved, the group will receive a group Provider Medicaid ID

• Entity – Organization, i.e. hospitals, Durable Medical Equipment (DME), nursing facilities. Individual providers cannot be linked to an entity

Provider Type

• Provider Type options are based on the Category selected

• See the Provider Type Summaries page for specific information about each Provider Type

Note: Category and Provider Type cannot be changed in this application after you leave this screen

Requested Effective Date

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

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

Are you changing Provider Types?

• This question only appears when one of the following Provider Types are selected; 3 (Behavioral Health Service Organization), 31 (Primary Care Center/ Federally Qualified Health Centers), 35 (Rural Health Clinic), 76 (Multi-Therapy Agency).

• If Yes is selected:

• A specific group of Provider Types (PT) are eligible to start a new application for a different provider type before ending the initial Medicaid ID. Example: A Medicaid Provider submits an application, and is approved for, a Medicaid ID using an individual provider type, when it should actually have been for a similar group or entity provider type.

• Applies to:

• PTs 79, 87, 88 moving to a PT 76 

• PT 66 moving to PT 03

• PT 65, 74, 78, 95, 52, 60, 62, 63, 67, 70, 77, 80, 81, 82, 83, 84, 85, 87, 88 moving to PT 31 or 35

• PT 31 moving to PT 35

• PT 35 moving to PT 31

• User will click the Add button, enter their Medicaid ID number and click Add to Grid. Validations will be performed when adding to the grid.

• If additional Medicaid IDs need to be changed, User will repeat this Add process to add all associated Medicaid IDs to be changed.

• If No is selected user will continue the application.

• If a Maintenance is in progress for one of the old Medicaid IDs, the Maintenance will need to be withdrawn or completed before the Provider Type change application can be started for identified Medicaid ID(s).

Birth Date – Individual Only (Age calculated from date of birth to current date)

• All Providers must be at least 18 years-old

• Chiropractors (Provider Type 85) must be at least 21 years-old

Primary 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

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

• A Provider may have multiple NPIs.  Enter the Primary NPI for this enrollment

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

Primary Taxonomy

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

• Select the Taxonomy Code on file with NPPES associated with the Primary NPI

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

Social Security # – Individual Only

• Individual Providers must enter their Social Security Number

• Credentialing Agents must enter the applicant’s Social Security Number

FEIN Number

• Individual Providers may only enter a FEIN if FEIN is owned 100% by the Individual Provider

• Group and Entity must enter its FEIN

Is this Application Change of Ownership (CHOW)?

• The Previous Owner’s Medicaid ID number is required for Change of Ownership

• If the Previous Owner’s Medicaid ID is associated to an Individual Provider Type, Change of Ownership cannot be selected

• When selecting Change of Ownership, Previous Owner’s Medicaid ID Provider Type must match requested Provider Type

• Provider Types 15 and 20 cannot do Change of Ownership

Is Your Primary Physical Business Location in Kentucky?

• Must be the primary practice location

Upon receipt of the KY Medicaid ID, I plan on applying to be a participating provider with the following KY Managed Care Organization(s).

• Select all that apply. Leave blank if you will not be applying to be a part of a Managed Care Organization.

If you are an MCO, select the MCO.

• If user is an employee of an MCO they will select the appropriate box for the MCO they are an employee of. Selecting an MCO here will cause the next field, MCO Identifier to appear.

MCO Identifier

• Enter the appropriate MCO Identifier. If you do not know the MCO Identifier, you will need to contact the MCO to acquire it.

Are you a subcontractor for the MCO?

• Selecting Yes will cause the Subcontractor Identifier field to appear. Enter the appropriate Subcontractor Identifier and click the Start New Enrollment button.

• If you do not know the Subcontractor Identifier, you will need to contact your employer, or your contact person at the MCO to acquire it.

• If No is selected, User will click the Start New Enrollment button to continue.

• System will verify MCO and Subcontractor Identifiers

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

Understanding Error Messages:

The NPI entered was not found on NPPES

• Verify the number entered is correct

• Verify the number in the NPPES NPI Registry

• If you have registered with NPPES in the last several days, your number may not yet be verifiable.  You may need to wait a day or two to enroll.

• If Provider has multiple NPIs, Provider may select another NPI registered on NPPES

Active Medicaid ID found with same NPI/Taxonomy

• Verify the number entered is correct

• Check to see if Provider already has a Medicaid ID with this NPI/Taxonomy combination.  If so, changes can be made in Maintenance/Revalidation.  If the Provider owns a KY Medicaid ID that did not appear on Provider’s dashboard, Provider should call the Contact Center to make the connection

• Multiple groups cannot use the same NPI/Taxonomy combination  

• Verify if your other Medicaid IDs have this Taxonomy already listed; if so:

• • You may need to select a different Taxonomy

  • You may need to register another Taxonomy

• For additional assistance, call the Contact Center

Inactive Medicaid ID found with same NPI/Taxonomy

• Verify the number entered is correct

• If Provider has a previous KY Medicaid ID, the Provider must use the “Re-Application” option on the dashboard

• For additional assistance, call the Contact Center

Pending application with same NPI/Taxonomy found

• Verify the NPI/Taxonomy combination entered is correct

• The Provider (or Provider’s agent) has already started a new application.   Check the Provider’s dashboard for a pending application

• A pending application does not appear on the Provider’s dashboard for one of the following reasons:

• • Credentialing Agent has not sent invitation to the Provider at time of new enrollment

  • The email address is not correct for the Provider

  • The email address is correct but the Provider has not set up a KOG account

  • The email address is correct, the Provider already has a KOG account, but Provider does not have access to Partner Portal application in KOG menu

• For additional assistance, call the Contact Center

An active Kentucky Medicaid Number has been found with the same Provider Type (Atypical Individual 56) and SSN (or FEIN)

• Verify the Social Security Number or FEIN entered is correct

• Check to see if the Provider already has a Medicaid ID with this Provider Type/SSN (or FEIN) combination.  If so, changes can be made in Maintenance/Revalidation.  If the Provider owns an active KY Medicaid ID that did not appear on Provider’s dashboard, Provider should call the Contact Center to make the connection

• If you do not have a Medicaid ID but one has been found, call the Contact Center for further assistance

A Pending application has been found with the same Provider Type (Atypical Individual 56) and SSN (or FEIN)

• Verify the Social Security Number or FEIN entered is correct

• The Provider (or Provider’s agent) has already started a new application.   Check the Provider’s dashboard for a pending application

• A pending application does not appear on the Provider’s dashboard for one of the following reasons:

• • Credentialing Agent has not sent invitation to the Provider at time of new enrollment

  • The email address is not correct for the Provider

  • The email address is correct but the Provider has not set up a KOG account

  • The email address is correct, the Provider already has a KOG account, but Provider does not have access to Partner Portal application in KOG menu

• For additional assistance, call the Contact Center