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Provider Enrollment Request

Interested in joining our network as a participating provider?

In order to participate with Passport Health Plan, you must:

  • Be eligible to participate with Kentucky Medicaid; and,

  • Have a practice location in one of the following counties:
    Jefferson, Oldham, Trimble, Carroll, Henry, Shelby, Spencer, Bullitt, Nelson, Washington, Marion, Larue, Hardin, Grayson, Meade, Breckinridge.

Meet the criteria above?

Submit a Provider Enrollment Request to begin the application process.

Behavioral health providers: 
Please contact the Kentucky Department for Medicaid Services (DMS) for participation. Behavioral health services are coordinated and covered by DMS. Visit www.chfs.ky.gov/dms/ for more information.

Dental providers: 
Please contact our dental vendor, MCNA, for participation at (877) 375-6262 or by visiting www.mcna.net.

Note: If you are an oral surgeon, you must apply for participation with both Passport Health Plan and MCNA. Please submit this request to begin the Passport Health Plan process and contact MCNA directly.

Vision providers: 
Please contact our vision vendor, Block Vision, for participation at (800) 428-8789 or by visiting www.blockvision.com.

Note: If you are an ophthalmologist, you must apply for participation with both Passport Health Plan and Block Vision. Please submit this request to begin the Passport Health Plan process and contact Block Vision directly.

Pharmacies: 
Please contact our pharmacy benefits manager, Perform Rx, for participation at (800) 578-0898 or by visiting www.performrx.com.

As a provider-sponsored Medicaid managed care plan, we believe your partnership is vital to our mission to improve the health and quality of life of our members. We also invite you to learn more about the Plan and our mission.

Thank you for your interest in partnering with us - we look forward to welcoming you into the Passport Health Plan network!

Please note, if you are already participating with the Plan, but would like to join a new or existing group, please contact the Provider Contracting department at (502) 585-8357 or (800) 578-0775 ext. 78357.