Interested in joining our network as a participating provider?

To join Passport’s provider network Click Here to Get Started

Adding a Provider to a Participating Group? Click here (Once this form is completed, please return, along with any other applicable information, via email to provider.enrollment@passporthealthplan.com)

Thank you for your interest in joining Passport Health Plan’s (Passport) network of participating providers. As a provider-sponsored Medicaid health plan, we believe your participation is vital to our mission to improve the health and quality of life of our members.

To join Passport’s network, you must be eligible to participate with Kentucky Medicaid and have a practice serving Kentucky residents. Passport’s network of providers includes medical doctors, specialists and now, as a result of Kentucky’s Medicaid expansion, is also accepting the following provider types:

  • Behavioral Health Multispecialty Group
  • Certified Social Workers working under the supervision of an LCSW
  • Licensed Behavior Analysts
  • Licensed Clinical Psychologists (LP)
  • Licensed Clinical Social Workers (LCSW)
  • Licensed Clinical Social Workers Group
  • Licensed Marriage & Family Therapists (LMFT)
  • Licensed Marriage & Family Therapists Group
  • Licensed Professional Art Therapists
  • Licensed Professional Clinical Counselors (LPCC)
  • Licensed Professional Clinical Counselors Group
  • Licensed Professional Counselor Associates working under the supervision of a Board-approved supervisor
  • Licensed Psychological Associates working under the supervision of an LP
  • Licensed Psychologists Group
  • Licensed Psychological Practitioners (LPP)
  • Licensed Psychological Practitioners Group
  • Marriage & Family Therapy Associates working under the supervision of an LMFT
  • Private Duty Nurses
  • Physical Therapists
  • Occupational Therapists
  • Speech Language Therapists

Please note, if you are already participating with Passport but would like to join an existing participating group, please complete this form.

    • Behavioral Health Providers
      All behavioral health providers,  facilities, Behavioral Health Service Organizations, and Community Mental Health Centers, please email PassportBehavioralHealth@passporthealthplan.com with any questions you may have.
    • Dental Providers
      Please contact our dental vendor, Avesis Third Party Administrators, Inc., for participation at (866) 909-1083 or by visiting Avesis.com.

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

    • Pharmacies
      Please contact our pharmacy benefits manager, CVS Pharmacy, (480) 314-8457 or by visiting here.