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Commonwealth of Kentucky
KY Medicaid
Provider Billing Instructions
for
Pharmacy Services
Provider Type 54
Version 1.3
March 1, 2023Document Change Log
VersionDateNameComments1.008/03/2022Vicky HicksCreated
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Healthcare professionals who provide specialized services that fall under provider type 54.
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What is provider type 54?
Provider Type 54 refers to a specific category or classification of healthcare providers.
Who is required to file provider type 54?
Healthcare providers who fall under the classification of Provider Type 54 are required to file.
How to fill out provider type 54?
Provider Type 54 can be filled out by providing the necessary information and data that pertains to this specific category of healthcare providers.
What is the purpose of provider type 54?
The purpose of Provider Type 54 is to accurately categorize and classify healthcare providers for regulatory and reporting purposes.
What information must be reported on provider type 54?
Provider Type 54 may require information such as provider name, identification number, services offered, patient demographics, etc.
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