Home
Forms Library
Kentucky medicaid provider enrollment

Change of address kentucky medicaid form 2026

kentucky medicaid provider enrollment Preview on Page 1

See details

4.4 out of 5

341 votes

The document is a Kentucky Medicaid Change of Information Form (MAP-529) used by providers to update their information, including name changes, address changes, and contact information. It outlines the required supporting documentation for various types of changes and includes a section for requesting the termination of a Medicaid number. The form must be returned to Kentucky Medicaid at the specified address.

Here's how it works

01. Edit your kentucky medicaid provider enrollment online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send change address medicaid via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out change of address kentucky medicaid form with DocHub

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the change of address Kentucky Medicaid form in our editor.
Begin by filling out the 'Current Existing Information' section. Enter the provider's name, number, NPI, and contact details accurately.
In the 'Change of Address Section', provide the new physical address, including street, city, state, zip code, and contact numbers for both physical and correspondence addresses.
If applicable, complete the 'Name Change Section' with the new name and reason for the change. Ensure you attach any required supporting documentation.
Review all entered information for accuracy. Use our platform’s features to highlight or mark any sections that need attention before finalizing.
Once completed, sign the form electronically using our editor and save your changes. You can then download or share it directly from our platform.

Start using our platform today to easily fill out your Kentucky Medicaid Change of Address form for free!

See more change of address kentucky medicaid form versions

We've got more versions of the change of address kentucky medicaid form form. Select the right change of address kentucky medicaid form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (255 Votes)
2009	4.4 Satisfied (341 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I update my Medicaid in KY?

If your account information is not current in kynect, your Medicaid coverage could be at risk so make sure to update it by visiting kynect.ky.gov or calling Kynect at 855-4kynect (855-459-6328).

How do I change my last name on HealthCare gov?

Update your application online Log in to your HealthCare.gov account. Choose the application you want to update. Click Report a Life Change on the left-hand menu. Read through the list of changes, and click Report a Life Change to get started. Select the kind of change you want to report.

How do I report a change of address to Medicaid?

To speak with someone about changes to your income, address or household situation, call 888-472-4463 MondayFriday, 8 a.m.5 p.m. or fax your changes to 805-658-4530.

How to change address kynect?

How to Update an Address A member can change an address through the kynect hotline (1-800-635-2570) or kynect online. Members can also visit or call their local DCBS office. A member can mail or fax this form to DMS.

How do I change my name after marriage in Kentucky?

You may either fax or mail the request to: Cabinet for Health and Family Services Department for Medicaid Services Managed Care Branch 275 East Main Street, 6W-A Frankfort, KY 40621 Fax: (502) 564-0509 Please be advised this process may take up to 90 days.

how do i notify medicaid of a change of address

Income limit for Medicaid in KY 2025 What is the monthly income limit for Medicaid in KY Medicaid income Limits KY for seniors Medicaid income limits ky family of 3 MAP 14 Kentucky Kentucky Medicaid asset limits Kentucky Medicaid Change of ownership Medicaid income Limits KY 2024

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

How do I change my name on my Ky Medicaid?

Please Note: Residents should call 855-306-8959 if they would like to update their name, date of birth, or Social Security number. Please call 855-459-6328 for additional updates or questions. The user must log into kynect benefits first before they can begin the Report a Change.