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Commonwealth of Kentucky
KY Medicaid
Provider Billing Instructions
for
EPS DT Treatment Services
Provider Type 45
Version 6.5
March 3, 2023Document Change Log
VersionDateNameComments1.010/12/2005EDSInitial
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How to fill out replaced provider rep list
How to fill out replaced provider rep list
01
Obtain the list of replaced providers from the designated source.
02
Review the list to ensure accuracy and completeness.
03
Fill out the necessary information for each replaced provider, such as name, contact information, and effective date of replacement.
04
Double check the filled out information for any errors or missing details.
05
Submit the completed replaced provider rep list to the appropriate department or individual.
Who needs replaced provider rep list?
01
Healthcare providers who have been replaced by new providers and need to be formally documented.
02
Healthcare organizations or institutions that require updated information on their provider network.
03
Insurance companies or managed care organizations that need to keep track of changes in their provider network.
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What is replaced provider rep list?
The replaced provider rep list is a list of previously employed providers who have been replaced.
Who is required to file replaced provider rep list?
The healthcare facility or organization is required to file the replaced provider rep list.
How to fill out replaced provider rep list?
To fill out the replaced provider rep list, you need to include the names and details of the providers who have been replaced.
What is the purpose of replaced provider rep list?
The purpose of the replaced provider rep list is to keep track of changes in provider staff and ensure accurate record-keeping.
What information must be reported on replaced provider rep list?
The replaced provider rep list must include the names of the providers who have been replaced, along with their position and the date of replacement.
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