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As of July 1, 2021, MedImpact is the pharmacy benefits manager for all Kentucky health plans offering coverage to Medicaid enrollees. As a result, MedImpact manages all prior authorization requests for medications. To submit a prior authorization request to MedImpact: Call 844-336-2676.
If you will be represented by a third party, whether in person or by correspondence, you must file a power of attorney specifically authorizing the individual to represent you or your organization. Kentucky Form 20A100 Declaration of Representative is used for this purpose.
For your POA to be valid in Kentucky, it must meet certain requirements. Mental Capacity for Creating a POA. Notarization Requirement. Create the POA Using Software or an Attorney. Sign the POA in the Presence of a Notary Public. Store the Original POA in a Safe Place. Give a Copy to Your Agent or Attorney-in-Fact.
A Kentucky durable power of attorney form is used by individuals to appoint a third party as their attorney-in-fact to handle any and all monetary decisions on their behalf. The agent cannot compensate themselves and must act in the principals best interests in every transaction.
estate. a marriage or legal separation is filed, unless the power of attorney document provides otherwise. Just as under the present law, a power of attorney is not required by the new law to be recorded, unless it is being use to convey, release or transfer any interest in real estate.

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Form 20A100 is provided for the taxpayers convenience. One form may be submitted to designate all tax types the Department is authorized to communicate with the authorized representative(s). You may revoke this form at any time.

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