State Guide

Credentialing in Kentucky

Enrollment guides for 52 payers operating in Kentucky.

What actually differs in Kentucky

Credentialing advice written for "most states" tends to be wrong here in specific, expensive ways. These are the rules that only apply in Kentucky.

4 sourced rules, each linked to its source

Getting enrolled 2 Who on your team can bill 1 Licensing and prescribing 1

4 sourced rules

Every claim on this page links to the statute, rule or agency page it came from. Last checked July 2026.

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Five MCOs after Anthem's exit (2025)

As of January 1, 2025, Anthem is no longer a Kentucky Medicaid MCO. The five current MCOs: Aetna Better Health of Kentucky, Humana Healthy Horizons in Kentucky, Passport Health Plan by Molina, UnitedHealthcare Community Plan, and WellCare of Kentucky, each requiring separate credentialing on top of DMS enrollment. Verify the member's current MCO for any patient previously on Anthem.

KY CHFS MCO Options via kb/states/ky.md · checked Jul 2026

Medicaid enrollment (MPPA, screen first) 907 KAR 1:671; 1:672

Kentucky Medicaid (DMS) enrolls providers through the Medicaid Partner Portal Application (MPPA), governed by 907 KAR 1:671 and 1:672, with claims and eligibility through KYHealthNet (Gainwell). DMS enrollment comes first, then separate credentialing with each MCO. A provider who stops at DMS enrollment can bill FFS but not the managed-care members, who are the majority.

KY DMS provider enrollment via kb/states/ky.md · checked Jul 2026

Associates reimbursable under supervision (24J = supervisor, modifier U4) 907 KAR 15:015; 15:005; PT-82 v2.8 / PT-83 v2.9 (2026-02-26)

Kentucky Medicaid explicitly recognizes associate-level BH practitioners (LPCA, CSW, MFTA, LPATA and others) as reimbursable under supervision at 52.5% of the Kentucky Medicare fee schedule, unusual generosity, but they cannot be credentialed: the Billing Supervisor's NPI goes in CMS-1500 field 24J (non-shaded), with modifier U4 flagging that the associate performed the service, and a monthly supervisory note recorded by the supervising professional. The billing supervisor must be an independent-level practitioner employed by or under contract with the same billing provider.

907 KAR 15:015 + DMS/Gainwell billing manuals via kb/states/ky.md · checked Jul 2026

Counseling Compact status + boards

Kentucky enacted the Counseling Compact in 2022 but is not yet issuing privileges as of July 2026. Three separate boards under the Department of Professional Licensing: Licensed Professional Counselors (LPCA at associate level, LPCC once clinical), Marriage & Family Therapists, and Social Work (CSW advancing to LCSW). No Kentucky prompt-credentialing statute has been identified. DMS enrollment can run 60+ days on incomplete applications.

counselingcompact.gov jurisdictions via kb/states/ky.md · checked Jul 2026

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Who Runs Kentucky Medicaid Provider Enrollment

50-state research

Enrollment Portal

MPPA (Medicaid Partner Portal Application)

Operated By

Gainwell Technologies

Platform

MPPA

From PayerReady's 50-state Medicaid enrollment platform research, verified July 2026. Portal contracts change; where an operator is in transition or not publicly confirmed, we say so rather than guess.

Aetna

Aetna (CVS Health)

Credentialing in Kentucky

What actually differs in Kentucky

Who Runs Kentucky Medicaid Provider Enrollment

Aetna

UnitedHealthcare

Cigna Healthcare

Anthem / Elevance Health

Humana

Centene Corporation

Molina Healthcare

Anthem Blue Cross and Blue Shield of Kentucky

Kentucky Medicaid

UnitedHealthcare Community Plan

Aetna Better Health

Molina Healthcare (Medicaid)

WellCare (Centene)

CareSource

Anthem HealthKeepers / Hoosier Healthwise

TRICARE

TRICARE East Region (Humana Military)

CHAMPVA

Delta Dental

Cigna Dental

MetLife Dental

Guardian Dental

Aetna Dental

United Concordia

DentaQuest

MCNA Dental

Liberty Dental Plan

Dental Network of America

VSP Vision Care

EyeMed Vision Care

Davis Vision

Spectera / UHC Vision

Optum Behavioral Health

Carelon Behavioral Health

Magellan Health

Evernorth Behavioral Health

Workers' Compensation

CGS Administrators (Jurisdiction 15)

CGS Administrators (DME B/C)

Ambetter

Anthem Blue Shield

Blue Cross Blue Shield

Carelon

Centene Corporation

Community Plan

Compsych

Medicaid

Medicare

Medicare Fee-for-Service (CMS)

Megellan

MultiPlan

WellCare

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