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- If a Maintenance is in progress for one of the old Medicaid IDs, the Maintenance will need to be withdrawn or completed before the Provider Type change application can be started for identified Medicaid ID(s).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