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The document outlines the enrollment process for providers seeking to participate in the Kentucky Medicaid program. It details the necessary steps, requirements, and documentation needed for application submission, including provider type, licenses, and financial information. The document emphasizes that enrollment does not guarantee reimbursement and highlights the importance of compliance with federal and state regulations. Additionally, it includes sections on ownership disclosure, attestation of qualifications, and penalties for false statements.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (166 Votes)
2015	4.4 Satisfied (170 Votes)
2015	4.4 Satisfied (244 Votes)
2010	4 Satisfied (57 Votes)

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