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KY Medicaid Provider Enrollment
August 23, 2010
10:00 am-4:30 pm
P.O. Box 2110
Frankfort, KY 40602
After the individual provider is enrolled, certain changes may occur. In order to keep their provider number current, the appropriate form or documentation must be submitted. Some of the most common changes/updates are the following:
- License Renewals
- Change of Address- Map-529 form
- Change of Name- A signed written request from individual provider requesting name change in addition to a new license and social security card reflecting the new name must be submitted.
- Linkage to group- Map-347 form