Kentucky Medicaid Providers
OFF CYCLE REVALIDATIONS
Kentucky Medicaid has been directed by the U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), to complete off-cycle revalidations over the next 24 months. The goal of this off-cycle revalidation is to ensure the accuracy of provider enrollment data and confirm that only legitimate, qualified providers are enrolled and participating. During this off-cycle revalidation, KY Medicaid will focus on providers that have not revalidated in the last 12 months. KY DMS will prioritize the review of identified providers in the following order: 1. High Risk Atypical (Providers with no NPI) 3. Moderate Risk 4. Limited Risk
Providers identified in any of these categories will be notified of their off-cycle revalidation requirement via notification from the Medicaid Partner Portal Application (MPPA) and will receive a revalidation letter outlining the action they need to take. These providers will need to submit a revalidation in MPPA, even if they revalidated in the last four years. KY Medicaid has 24 months to complete this off-cycle revalidation. Due to this deadline, it is imperative that providers complete their revalidation and submit it as soon as they receive their notification/ letter. This will allow DMS to review and process these revalidations in a timely manner, prevent provider billing issues and meet the required deadline. Any updates that need to be made to a provider file can be included in the revalidation instead of submitting a separate maintenance.
KY MEDICAID PROVIDER REIMBURSMENT CUTS
As a result of House Bill 500 not providing sufficient funding for the Department to continue operating the Medicaid program at current service and reimbursement levels, DMS will implement a 4% reduction in Medicaid provider reimbursement rates for the provider types identified in this letter to KY Medicaid providers effective Aug. 1, 2026, or the earliest administratively feasible date thereafter.
GLMS is seeking to understand how these reimbursement reductions may affect physician practices across our community.
Please let us know:
